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Text-Book  of  Hygiene 


A  COMPREHENSIVE   TREATISE 


Principles  and  Practice  of  Preventive  Medicine 


FROM  AN   AMERICAN  STAND-POINT. 


BY 

GEORGE   H.    ROHE   M.D., 

PROFESSOR  OF  OBSTETRICS  AND  HYGIENE  IN  THE  COLLEGE  OF  PHYSICIANS  AND  SURGEONS,   BALTIMORE  ;   DIRECTOR  OF 

THE   MARYLAND   MATERNITE  ;     MEMBER    OF  THE    AMERICAN   PUBLIC    HEALTH    ASSOCIATION  ;    FOREIGN 

ASSOCIATE  OF   THE  SOCIETE    FRANIJAISE   D'HYGIENE,   OF  THE  SOCIETE  DES  CHEYALIERS- 

SAUYETEURS  DES  ALPES   MARITIMES,  ETC. 


SECOND    EDITION 

Thoroughly  Revised  and   Largely   Rewritten,  with  Many 

Illustrations  and  Valuable  Tables. 


PHILADELPHIA  AND  LONDON: 

F.    A.    DAVIS,    PUBLISHER, 
1890. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/textbookofhygien1890roh 


PREFACE  TO  THE  FIRST  EDITION. 


The  aim  of  the  author  in  writing  this  book  has  been  to 
place  in  the  hands  of  the  American  student,  practitioner, 
and  sanitary  officer,  a  trustworthy  guide  to  the  principles 
and  practice  of  preventive  medicine. 

He  has  endeavored  to  gather  within  its  covers  the  essen- 
tial facts  upon  which  the  art  of  preserving  health  is  based, 
and  to  present  these  to  the  reader  in  clear  and  easily 
understood  language. 

The  author  cannot  flatter  himself  that  much  in  the 
volume  is  new.     He  hopes  nothing  in  it  is  untrue. 


(v) 


PREFACE  TO  THE  SECOND  EDITION. 


In  the  present  edition  the  author  has  endeavored  to  in- 
corporate the  advances  made  in  sanitary  science  and  art  since 
the  issue  of  the  first  edition. 

Additions  will  be  found  upon  nearly  every  page,  and 
some  of  the  chapters  have  been  almost  entirely  rewritten. 
The  size  of  the  book  has  been  increased  about  one  hundred 
pages,  and  illustrations  have  been  introduced  wherever 
thought  requisite.  The  thanks  of  the  author  are  due  to 
Medical  Director  Albert  L.  Gihon,  United  States  Navy,  for 
revising  the  chapter  on  Naval  Hygiene,  and  to  Surgeon 
Walter  Wyman,  United  States  Marine-Hospital  Service,  for 
supplying  the  chapter  on  Quarantine. 


(vii) 


TABLE  OF  CONTENTS. 


CHAPTER  I.  PAGE 

Air, 1 

CHAPTER  II. 
Water, 45 

CHAPTER  III. 
Food,    c 81 

CHAPTER  IV. 
Soil, 121 

CHAPTER  V. 
Removal  of  Sewage,    .        .    • 135 

CHAPTER  VI. 

Construction  of  Habitations,      .        ..        .        .        .151 

CHAPTER  VII. 
Construction  of  Hospitals, 179 

CHAPTER  VIII. 
School  of  Hygiene, .192 

CHAPTER  DL 

Industrial  Hygiene     .         .        .        .        ;        .        .207 

CHAPTER  X. 

Military  and  Camp  Hygiene,      .        .        .         .         .231 

(ix) 


TABLE    OF    CONTEXTS. 

CHAPTER  XL 


PAGE 


Naval  Hygiene, 243 

CHAPTER  XII. 
Prison  Hygiene,  .         . 255 

CHAPTER  XIII. 

Exercise  and  Training,        .         .         .         .         .         .261 

CHAPTER  XIV. 

BAths  and  Bathing.     .  , 267 

CHAPTER  XV. 
Clothing,     .........     275 

CHAPTER  XVI. 

Disposal  of  the  Dead,         . .     ■ 279 

CHAPTER  XVII. 

The  Germ  Theory  of  Disease,     .....     285 

CHAPTER  XVIII. 

Contagion  and  Lstfectiqn,    .         ...         .        .         .     289 

CHAPTER  XIX. 

History  of  Epidemic  Diseases, 29  c 

CHAPTER  XX. 


Antiseptics,  Disinfectants,  and  Deodorants, 

.     347 

CHAPTER  XXI. 

Vital  Statistics,  . 

.     359 

CHAPTER  XXII. 

Quarantine, 

.     365 

.     417 

Text-Book  of  Hygiene. 


CHAPTER  I. 

Air. 


Exact  investigation  into  the  influence  of  the  atmosphere 
upon  health  is  yet  in  its  infancy.  Enough  has  been  learned, 
however,  to  show  that  changes  in  the  composition  of  the  air,  hi 
its  density,  its  temperature,  its  humidity,  its  rate  and  direction 
of  motion,  and  possibly  its  electrical  or  magnetic  conditions, 
influence  in  various  ways  the  health  of  the  individual.  It  is 
only  very  recently  that  any  scientific  attempts  have  been  made 
to  trace  the  bearing  of  atmospheric  changes  upon  health.  The 
observations  already  recorded  indicate  that  a  thorough  study  of 
meteorological  phenomena  in  connection  with  the  origin  and 
progress  of  certain  diseases  is  a  promising  field  of  labor  for  the 
educated  sanitarian.  The  meteorological  observations  which 
have  been  gathered  by  the  United  States  Signal  Service  during 
the  past  eighteen  years,  together  with  the  elaborate  studies 
made  by  the  meteorologists  and  climatologists  of  other  countries, 
already  form  such  a  large  and  tolerably  complete  and  well- 
arranged  body  of  facts,  that  reasonably  accurate  deductions  can 
even  now  be  made.  Heretofore,  in  studying  the  sanitary  rela- 
tions of  the  atmosphere,  both  in  this  country  and  abroad,  the 
attention  of  observers  has  been  riveted  almost  exclusively  upon 
the  changes  in  its  composition  occurring  within  certain  limited 
areas.  It  is,  perhaps,  equally  important  to  study  this  universally 
diffused  and  necessary  condition  of  vital  activity  in  its  broader 
and  more  general  relations.  It  will  be  shown,  in  the  course  of 
the  present  work,  that  the  meteorological  features  of  countries, 

(i) 


2  TEXT-BOOK   OF   HYGIENE. 

or  of  seasons,  or  even  the  daily  atmospheric  changes,  exercise  an 
important  influence  upon  life  and  health.  In  order  to  fully 
appreciate  these  relations  it  will  be  necessary  to  first  give  a  brief 
summary  of  the  facts  and  laws  of  meteorology. 

THE    COMPOSITION   AND   PHYSICAL   CONDITIONS   OF  THE  ATMOSPHERE. 

Atmospheric  air  is  a  mixture  of  four-fifths  of  nitrogen  and 
one-fifth  of  oxygen;  more  accurately,  79.00  of  the  former  to 
20.96  of  the  latter.  In  addition,  there  is  constantly  present  a 
modicum  of  carbon  dioxide,  usually  a  little  over  .03  per  cent. 
(3  to  4  parts  in  10,000),  traces  of  ammonia  and  nitric  acid,  and 
a  variable  proportion  of  vapor  of  water. 

These  proportions  are  maintained,  with  but  very  little 
change,  at  different  heights.  At  first  thought,  it  would  seem 
that  carbon  dioxide,  being  much  heavier  than  the  other  con- 
stituents of  air,  would  accumulate  in  the  lower  regions  of  the 
atmosphere,  and  there  cause  an  excess  of  this  poisonous  con- 
stituent, but  in  obedience  to  the  law  of  diffusion  the  interming- 
ling of  the  component  gases  is  perfect,  and  the  proportion  of 
carbon  dioxide  in  the  atmosphere  is  quite  as  great  on  mountain- 
tops  as  in  the  deepest  valleys. 

The  proportion  of  nitrogen  in  atmospheric  air  is  generally 
uniform,  while  that  of  oxygen  varies,  depending  to  a  great  ex- 
tent upon  the  amount  of  carbon  dioxide  present.  Hence,  an 
increase  in  the  amount  of  the  latter  constituent  is  usually  ac- 
companied by  a  diminution  of  oxygen,  inasmuch  as  the  formation 
of  carbon  dioxide  can  only  take  place  at  the  expense  of  oxygen. 
The  reciprocal  activities  of  animal  and  vegetable  life  are  beauti- 
fully illustrated  by  these  relations  between  the  oxygen  and 
carbon  dioxide  in  the  air.  In  the  processes  of  combustion  and 
oxidation,  oxygen  is  withdrawn  from  the  atmosphere,  and  com- 
bines with  carbon,  forming  carbon  dioxide.  During  vegetable 
growth,  on  the  other  hand,  carbon  dioxide  is  withdrawn  from 
the  air  by  the  leaves  of  plants,  and  decomposed  into  its  elements, 
carbon  and  oxygen.     The  carbon  is  used  in  building  up  the 


COMPOSITION    AND    PHYSICAL    CONDITIONS   OF   ATMOSPHERE.         3 

plant,  while  the  liberated  oxygen  is  restored  to  the  atmosphere. 
The  animal  consumes  oxygen,  and  gives  out  carbon  dioxide; 
the  plant  resolves  this  compound  into  its  constituent  elements, 
and  gives  back  the  oxygen  to  the  air  again. 

Some  recent  experiments  of  Jolly  have  shown  that  on  days 
of  northerly  winds  the  proportion  of  oxygen  is  higher  than  the 
average,  while  under  the  influence  of  the  south  wind  the  propor- 
tion of  oxygen  is  deficient.  The  extremes  in  a  series  of  21 
observations  were  21.01  and  20.53  per  cent.  The  difference, 
.48  per  cent.,  is  too  small  to  have  any  appreciable  influence 
upon  health. 

The  atmosphere  extends  upward  from  the  surface  of  the 
earth  to  an  indefinite  distance.  The  limit  has  been  variously 
placed  at  from  75  kilometres  to  40,000  kilometres.  For  all 
sanitary  purposes  the  former  may  be  taken  as  the  upward  limit 
of  the  atmosphere.  In  obedience  to  the  law  of  gravity,  this 
mass  of  air  everywhere  presses  directly  downward — toward  the 
earth's  centre — with  a  force  equal  to  its  weight.  If  a  column 
of  this  air  be  balanced  by  a  column  or  mass  of  any  other  matter — 
the  columns  being  of  the  same  diameter — we  have  a  relative 
measure  of  the  weight  of  the  atmosphere.  The  instrument  with 
which  the  weight  or  downward  pressure  of  the  air  is  measured 
is  called  a  barometer.  The  atmosphere,  at  the  sea-level,  presses 
downward  with  a  force  equal  to  the  pressure  of  a  column  of 
mercury  760  millimetres  high.  Hence,  the  barometric  pressure 
at  sea-level  is  said  to  be  760  millimetres,  or  30  inches.  If  the 
barometer  be  carried  to  the  summit  of  a  mountain  1000  metres 
above  the  level  of  the  sea,  or  taken  to  the  same  altitude  in  a 
balloon,  the  mercury  in  the  barometer-tube  will  fall  about 
90  millimetres.  These  90  millimetres  of  the  mercurial  column 
represent  the  weight  of  1000  metres  of  air  now  below  the 
barometer,  and  consequently  not  measured  or  balanced  by  it.1 

Upon  ascending  from  the  sea-level,  it  is  found  also  that  the 

1  The  figures  here  given  are  not  absolute,  but  merely  approximate.  The  limits  of  this 
work  do  not  allow  a  full  discussion  of  the  meteorological  elements  modifying  the  pressure  of 
the  atmosphere  at  sea-leveL 


TEXT-BOOK   OF    HYGIENE. 


air,  being  less  pressed  upon  by  that  which  is  still  above  it, 
becomes  more  rarefied  and  lighter;  its  tension,  as  it  is  termed, 
is  less.  Hence,  for  the  second  1000  metres  of  ascent  above  the 
sea,  the  mercury  will  fall  a  less  distance  in  the  tube,  the  weight 
removed  not  being  so  great  as  in  the  first  1000  metres. 

The  following  table  shows  the  diminution  in  atmospheric 
pressure  for  every  1000  metres  above  sea-level: — 

Table  I. 

Height. 
Sea-level, 

1,000  metres, 

2,000       " 

3,000       " 

4,000       " 

5,000       " 

6,000       " 

7,000       " 

8,000       " 

9,000  " 
10,000  " 
11,000  " 
12,000  " 
15,000  " 
20,000       " 

Variations  in  temperature  and  humidity  of  the  air  influence 
the  tension  of  the  atmosphere  in  a  marked"  degree,  and  affect 
the  height  of  the  barometric  column.  In  fact,  most  of  the 
changes  of  atmospheric  pressure  at  the  surface  of  the  earth  are 
directly  due  to  changes  in  temperature  and  humidity.  Increase 
of  temperature  diminishes  the  density  of  .the  air.  Hence,  when 
the  temperature  rises  the  pressure  decreases. 

The  proportion  of  moisture  (aqueous  vapor),  if  increased, 
likewise  causes  a  diminution  in  pressure.  It  is  found,  for  ex- 
ample, that  when  the  amount  of  aqueous  vapor  in  the  air 
increases  the  barometer  falls.  This  is  due  to  the  fact  that  the 
specific  gravity  of  aqueous  vapor  is  less  than  that  of  dry  air, 
being  in  the  proportion  of  .623  to  1.000.     Hence,  as  aqueous 


Barometric  Pressure. 

160.0  millimetres. 

670.4 

u 

591.5 

u 

521.0 

a 

460.3 

u 

406.0 

a 

358.2 

u 

316.0 

u 

278.8 

u 

245.9 

u 

216.9 

a 

191.1 

u 

168.8 

a 

115.9 

u 

61.9 

» 

COMPOSITION    AND    PHYSICAL   CONDITIONS    OF    ATMOSPHERE.        5 

vapor  is  diffused  through  air,  the  latter  becomes  lighter, — or,  in 
other  words,  the  barometric  pressure  diminishes. 

The  warmth  of  the  air  is  primarily  derived  from  the  sun. 
On  a  clear  day  about  one-fourth  of  the  heat  of  the  sun's  rays  is 
given  off  directly  to  the  air  during  the  passage  of  the  heat- 
rays  to  the  earth.  Of  the  remaining  three-fourths,  part  is  re- 
flected from  the  earth,  while  the  larger  portion  is  first  absorbed 
by  the  earth,  and  then  given  off  by  radiation  and  convection  to 
the  superincumbent  air. 

The  air  is  always  warmer  near  the  earth's  surface  on  a  clear, 
sun-shiny  day;  for,  as  soon  as  the  earth  gets  warmer  than  the 
air  immediately  above  it,  the  excess  of  heat  is  given  off  to  the 
latter  by  convection  and  radiation.  On  ascending  from  the 
surface  of  the  earth  the  temperature  decreases,  and  on  the 
summit  of  a  high  mountain  the  air  is  always  colder  than  at 
its  base. 

Professor  Tyndall  has  shown  that  dry  air  absorbs  less 
heat  than  air  which  is  charged  with  vapor.  For  this  reason 
the  sun's  rays  strike  the  earth  with  much  greater  intensity 
on  a  very  dry  than  on  a  moist  day,  while  on  the  latter  a  larger 
proportion  of  the  heat-rays  is  intercepted  before  they  reach 
the  earth. 

Recent  experiments  seem  to  show,  however,  that  the  differ- 
ence in  diathermancy  between  dry  and  humid  air  is  not  so  great 
as  supposed  by  Tyndall.  The  depth  of  the  air-stratum,  through 
which  the  sun's  rays  pass,  is  of  greater  influence  than  the 
humidity. 

Air,  at  different  temperatures,  is  capable  of  absorbing 
different  amounts  of  aqueous  vapor.  Thus,  air  at  a  temperature 
of  4°  will  require  a  much  smaller  amount  of  vapor  to  produce 
saturation  than  air  at  a  temperature  of  30°.  For  this  reason 
air  which  appears  "  damp "  at  the  former  temperature,  both  to 
the  bodily  sensations  and  to  appropriate  instruments,  would  be 
considered  as  "dry"  at  the  latter  temperature,  although  the 
actual  amount  of  vapor  present,  or  absolute  humidity,  is  the 


6  TEXT-BOOK   OF    HYGIENE. 

same  in  both  cases.1  In  meteorological  observations  for  sanitary 
purposes,  the  relative  humidity  is  the  condition  deserving 
especially  careful  study. 

It  must  be  borne  in  mind  that  the  mere  statement  of  the 
percentage  of  relative  humidity,  without  taking  into  account  the 
temperature  of  the  air,  is  of  little  significance.  A  like  remark 
is  justified  with  regard  to  statements  of  absolute  humidity,  when 
used  to  illustrate  the  apparent  effects  of  atmospheric  moisture 
upon  life  and  health. 

The  following  table  shows  the  absolute  humidity  corre- 
sponding to  the  same  relative  humidity  at  different  tempera- 
tures. It  also  includes  the  total  possible  absolute  humidity 
and  the  difference  between  the  actual  and  possible  humidity 
(deficiency  of  saturation)  at  the  temperatures  given  : — 


Table  II. 


Tempera- 
ture °C. 

Relative 
Humidity 

(per  cent.). 

Absolute  Humidity 
(grammes  per 
cubic  metre). 

Greatest  Possible 
Absolute  Humidity. 

Deficiency  of 
Saturation. 

—20 

—10 

0 
+  10 

20 

30 

60 
60 
60 
60 
60 
60 

0.638 
1.380 
2.924 
5.623 
10.298 
18.083 

1.064 
2.300 
4.874 
9.372 
17.164 
30.139 

0.426 
0.920 
1.950 
3.749 
6.866 
12.056 

In  forests  the  relative  humidity  is  usually  higher  than  over 
unwooded  districts,  although  the  absolute  humidity  may  be  the 
same,  or,  perhaps,  even  less.  The  evaporation  is  usually  much 
greater  in  the  open  air  than  in  forests.  In  closed  apartments 
the  evaporation  may  be  greater  or  less  than  in  the  open  air,  de- 
pending upon  the  local  conditions  present. 

1  By  "  absolute  humidity"  is  meant  the  total  amount  of  vapor  present  in  a  certain  mass 
of  air.  By  the  term  "relative  humidity "  meteorologists  designate  the  proportion  of  vapor 
present  at  certain  temperatures,  compared  with  full  saturation  of  the  air  with  vapor,  which  is 
reckoned  100.  Thus,  air  which  is  saturated,  or  whose  relative  humidity  is  100  at  4°,  would  have 
a  relati  v'e  humidity  of  only  24,  if  the  temperature  were  raised  to  27°,  because  in  the  latter  case 
the  capacity  of  the  air  for  aqueous  vapor  is  increased.  Relative  humidity  is  always  designated 
in  percentages  ;  absolute  humidity  in  grammes  per  cubic  metre  or  grains  per  cubic  foot. 


COMPOSITION"   AND   PHYSICAL    CONDITIONS    OF    ATMOSPHERE.         7 

The  motion  of  the  air — wind — is  caused  by  differenecs  in 
pressure ;  the  latter  being  due  to  differences  in  temperature  and 
humidity.  A  mass  of  air  traversing  a  large  body  of  water  absorbs 
vapor,  unless  already  saturated,  and  becomes  moist;  if  it  pass 
over  a  wide  tract  of  dry  land  it  loses  moisture  and  becomes  dry. 
Therefore  in  the  eastern  portion  of  the  American  continent,  an 
easterly  or  southerly  wind,  which  comes  from  over  large  bodies 
of  water,  and  which  is  usually  warm,  and  thus  capable  of  hold-- 
ing  a  large  quantity  of  water  in  a  state  of  vapor,  is  always 
moist.  On  the  other  hand,  a  northerly  or  westerly  wind,  com- 
ing over  a  large  extent  of  dry  land,  and  from  a  colder  region,  is 
nearly  always  a  dry  wind.  On  the  Pacific  coast  these  condi- 
tions are  reversed ;  there  a  westerly  wind  is  a  moist  wind,  while 
an  easterly  wind  is  dry.  The  dreaded  easterly  wind  of  England 
is  likewise  a  dry  wind.  It  is  probable  that  the  direction  and 
rate  of  motion  of  air-currents  have  considerable  influence  upon 
the  origin  or  intensification  of  certain  diseases. 

The  electrical  and  magnetic  conditions  of  the  atmosphere 
have  been  as  yet  studied  to  little  advantage.  It  is  only  known 
that  atmospheric  electricity  is,  in  most  cases,  positive,  and  that 
its  intensity  increases  with  condensation  of  vapor.  There  seems 
to  be  no  doubt  that  the  varying  states  of  atmospheric  electricity 
are  closely  connected  with  evaporation  and  condensation.  There 
is  reason  to  believe  that  a  fuller  knowledge  on  these  topics  will 
yield  most  important  results  to  the  student  of  hygiene. 

Ozone  and  antozone,  or  hydrogen  peroxide,  are  usually 
present  in  the  atmosphere  in  varying  proportions.  Careful  and 
extended  observations  have  failed  to  show  any  connection  be- 
tween the  presence  of  these  agents  in  the  atmosphere  and  modi- 
fications of  health.  It  is  probable  that  the  sanitary  importance 
of  ozone  and  of  hydrogen  peroxide  have  been  much  overrated. 
It  is  not  known  that  either  of  these  substances  has  any  other 
function  in  the  atmosphere  than  that  of  an  oxidizing  agent. 

The  sanitarian  should  be  a  practical  meteorologist.  In 
addition  to  a  knowledge  of  the  principles  of  the  science,  he 


8 


TEXT-BOOK   OF   HYGIENE. 


should  possess  the  skill  to  make  accurate  observations  of  me- 
teorological conditions,  and  estimate  their  significance.  But  the 
acquisition  of  an  elaborate  collection  of  instruments,  and  their 
regular  observation,  is  too  expensive  and  time-consuming.     A 

German  physicist,  Lambrecht,  has  de- 
vised an  instrument  which  combines  in 
itself  nearly  all  the  requirements  of  a 
trustworthy  meteorological  instrument 
(Fig.  1).  This  instrument  is  called  a 
polymeter,  and  shows,  on  easily-readable 
scales,  the  temperature,  relative  humid- 
ity, dew-point,  absolute  humidity  in 
grammes  per  cubic  metre,  and  vapor 
tension. 

INFLUENCE  OF  CHANGES  OF  ATMOSPHERIC 
PRESSURE  ON  HEALTH. 

The  efTects  of  a  considerable  dimi- 
nution of  pressure  are  familiar  to  every 
one  in  the  ';  mountain  sickness  "  which 
attacks  most  persons  on  ascending  high 
mountains.  M.  Bert  has  shown  experi- 
mentally that  similar  effects  can  be 
produced  in  an  air-tight  chamber  by 
diminishing  the  pressure.1  The  symp- 
toms produced  under  a  pressure  equiva- 
lent to  an  altitude  of  from  4000  metres 
to  5000  metres  were  a  feeling  of  heavi- 
ness, nausea,  ocular  fatigue,  rapidity 
of  pulse,  convulsive  trembling  on  slight 
exertion,    and   a   sensation  of  languor 

and  general  indifference  to  the  surroundings  of  the  individual. 
M.  Lortet,  who  has  left  on  record  his  experiences  in  the 

higher  Alps,  says  that  the   symptoms  noticed  on  ascending  to 

1  Popular  Science  Monthly,  v,  p.  379. 


Fig.  1. 

IjAMEkecht's  Polymeter. 


INFLUENCE    OF    CHANGES    OF    ATMOSPHERIC    PRESSURE.  9 

high  altitudes  are:  Labored  respiration,  increased  rapidity  of 
pulse,  depression  of  temperature  (as  much  as  4°  to  7°  C).  The 
normal  temperature  was  restored,  however,  after  a  brief  rest.1 
Still  more  severe  symptoms  have  been  noticed  on  ascending  high 
mountains  in  South  America  and  Asia.  Aeronauts  have  lost 
consciousness,  and  in  several  instances  life,  on  rapidly  ascending 
to  great  altitudes.2  According  to  the  observations  of  the 
brothers  Schlagintweit,  distinguished  explorers  of  the  highlands 
of  Asia,  the  effects  of  diminished  pressure  upon  the  human 
organism  are  :  "  Headache,  difficulty  of  respiration,  and  affec- 
tions of  the  lungs, — the  latter  even  proceeding  so  far  as  to 
occasion  blood-spitting, — want  of  appetite,  and  even  nausea, 
muscular  weakness,  and  a  general  depression  and  lowness  of 
spirits.  All  these  symptoms,  however,  disappear  in  a  healthy 
man  almost  simultaneously  with  his  return  to  lower  regions." 
A  singular  observation  was  made  by  these  travelers  on  the  effect 
of  motion  of  the  air  upon  the  symptoms  described.  They  say: 
"  The  effects  here  mentioned  were  not  sensibly  increased  by 
cold,  but  the  wind  had  a  most  decided  influence  for  the  worse 
upon  the  feelings When  occupied  with  observa- 
tions, we  took  very  little,  if  any,  bodily  exercise,  sometimes  for 
thirty-six  hours;  it  would  frequently  occur  nevertheless,  even  in 
heights  not  reaching  17,000  feet  (about  5150  metres),  that  an 
afternoon  or  evening  wind  would  make  us  all  so  sick  as  to  take 
away  every  inclination  for  food.  No  dinner  was  cooked;  the 
next  morning,  when  the  wind  had  subsided,  the  appetite  was 
better. 

"  The  effects  of  diminished  pressure  are  considerably  aggra- 
vated by  fatigue.  It  is  surprising  to  what  degree  it  is  possible 
for  exhaustion  to  supervene  ;  even  the  act  of  speaking  is  felt  to 
be  a  labor,  and  one  gets  as  careless  of  comfort  as  of  danger. 
Many  a  time  our  people — those  who  ought  to  have  served  us  as 
guides — would  throw  themselves  down  upon  the  snow,  declaring 

1  Realencyclopsedie  d.  ges.  Heilk.,  v.,  p.  529. 

2  MM.  Siveland  Croce-Spinelli,  two  aeronauts,  lost  their  lives  in  this  manner  during  an 
ascent  from  Paris,  in  April,  1875. 


10  TEXT-BOOK   OF   HYGIENE. 

they   would   rather   die   upon   the   spot   than  proceed  a  step 
farther."1 

These  symptoms  disappear  when  persons  are  exposed  to 
these  conditions  for  a  prolonged  time.  Thus,  in  the  Andes 
there  are  places  4000  metres  above  sea-level  which  are  per- 
manently inhabited ;  and  in  the  Himalayas  there  are  villages 
at  a  height  of  over  5000  metres  constantly  occupied.  In  this 
country,  Pike's  Peak,  4350  metres  above  the  sea,  has  been 
occupied  since  1873  by  observers  of  the  signal  service.  The 
men  seem  to  become  acclimated,  as  it  were,  and  suffer  little  or 
no  inconvenience  from  the  diminished  pressure  after  a  time. 

The  minor  disturbances  of  healthy  function  produced  by 
diminished  pressure  (within  the  limits  of  4000  metres  altitude, 
or  460  millimetres  barometric  pressure)  are  an  increase  in  the 
pulse  and  respiration  rate.  This  is  probably  due  to  the  struggle 
of  the  organism  to  take  up  the  required  quantity  of  oxygen 
which  is  reduced  in  proportion  by  the  rarefaction  of  the  air. 
For  example,  the  proportion  of  oxygen  at  a  pressure  of  460 
millimetres  would  be  equivalent  to  12.6  per  cent,  at  sea-level, 
instead  of  the  normal  20.9  per  cent. 

Paul  Bert  has  shown  by  personal  experiments  in  the 
pneumatic  chamber  that  the  increase  in  pulse  and  respiration 
rate  is  not  due  to  the  merely  mechanical  diminution  of  pressure, 
but  to  the  deficiency  of  oxygen.  Hence  the  physiological  effects 
of  high  altitudes  upon  circulation  and  respiration  are  not  purely 
physical,  due  to  diminished  pressure,  but  vital,  and  depend  upon 
the  change  in  the  chemical  composition  of  the  atmosphere. 
The  simple  diminution  of  oxygen  without  reduction  of  pressure 
will  produce  similar  though  not  identical  effects  upon  the 
organism. 

Above  the  height  of  4000  metres  above  sea-level  (below 
460  millimetres  pressure)  the  profounder  disturbances  of  func- 
tion characterized  as  "  mountain  sickness  "  come  on.     Different 

1  Results  of  a  Scientific  Mission  to  India  and  High  Asia.  By  Hermann,  Adolphe,  and 
Robert  De  Schlagintweit,  vol.  ii,  pp.  484,  485. 


INFLUENCE    OF   CHANGES   OF    ATMOSPHERIC   PRESSURE.  11 

individuals  react  in  different  degree  to  the  morbific  influences  of 
greatly  diminished  atmospheric  pressure  (and  coincident  reduc- 
tion of  oxygen).  Thus  Glaisher  reached  an  elevation  of  11,000 
metres  (191.1  millimetres  pressure)  and  returned  to  the  earth 
alive,  while  Croce-Spinelli  and  Sivel  perished  at  the  considerably 
lower  elevation  of  8000  metres,  equivalent  to  a  pressure  of  260 
millimetres  (7.2  per  cent,  of  oxygen). 

The  sanitarian  is  most  concerned  about  the  effects  of  press- 
ure of  the  atmosphere  from  760  millimetres  down  to  460  milli- 
metres (or  up  to  an  altitude  of  4000  metres  above  sea-level). 
The  climato therapy  of  various  diseases  requires  that  the  effects 
of  variations  of  pressure  between  these  limits  should  be  carefully 
studied.  The  observations  of  Mermod  and  Jourdanet1  have 
illustrated  the  common  physiological  effects  of  these  circum- 
scribed changes,  while  the  experiences  of  therapeutists  have 
established  the  fact  very  clearly  that  many  cases  of  phthisis 
improve  markedly  in  a  rarefied  atmosphere.  Other  observers 
have  also  shown  that  the  effects  of  diminished  pressure  are  not 
always  beneficial,  and  Dr.  Loomis  has  warned  against  the  send- 
ing of  patients  with  heart  disease  to  high  altitudes.  Whether 
the  lethal  effects  that  have  been  recorded  in  such  cases  are  due 
to  the  increased  activity  of  the  heart  and  heightened  blood- 
pressure  from  deficient  oxygen,  or  as  suggested  by  Dr.  F.  Don- 
aldson, Jr.,  to  dilatation  of  the  heart- walls  from  diminution  of 
external  pressure,  is  as  yet  unsettled.2 

It  is  probable  that  the  diurnal  or  accidental3  oscillations  of 
barometric  pressure  at  sea-level  have  no  appreciable  influence 
upon  the  organism.  The  statement  is  occasionally  met  that 
patients  subjected  to  grave  surgical  operations  oftener  do  badly 
during  low  atmospheric  pressure,   and   some    surgeons   never 


1  Jourdanet  states  that  while  the  French  and  Belgian  soldiers  in  Mexico  had  an  accel- 
erated pulse,  the  natives  had  a  normal  pulse.  In  Mermod' s  observations  the  average  frequency 
of  the  pulse  at  St.  Croix  (1106  metres  above  sea-level)  was  nearly  four  beats  greater  than  at  Strass- 
burgh  (142  metres).  The  condition  of  the  natives  at  the  high  settlements  of  the  Andes  and  Hima- 
layas has  not  yet  been  investigated  with  exactitude. 

2  American  Climatological  Association,  1S87. 

3  Meaning  the  oscillation  produced  by  storm  waves. 


12  TEXT-BOOK   OF   HYGIENE. 

operate  when  the  barometer  is  low  or  falling  if  they  can  avoid 
it.  An  inquiry  undertaken  by  the  writer  in  1876,  in  which  the 
excellent  records  of  the  Massachusetts  General  Hospital  and  the 
observations  of  the  Boston  station  of  the  United  States  Signal 
Service  for  five  years  were  used  as  the  basis  of  comparison, 
resulted  negatively.  The  deaths  following  operations  done  on 
days  when  the  barometer  was  high  or  rising  were  exactly  equal 
in  number  to  those  following  operations  when  the  barometer 
was  low  or  falling.  Unfortunately,  the  investigation  was  never 
pursued  to  the  extent  of  including  other  meteorological  elements, 
such  as  humidity,  cloudiness,  precipitation,  etc.  The  numerous 
studies  of  the  relations  of  variations  of  pressure  to  the  progress 
of  infectious  diseases  have  also  failed  to  yield  any  fruits  of  value. 
Whether  the  nerve-pains  so  frequently  complained  of,  especially 
by  elderly  patients,  during  the  progress  of  areas  of  low  barometer, 
are  due  to  the  diminished  pressure,  or  to  the  influence  of  some 
other  meteorological  factor,  such  as  humidity  or  electrical  con- 
dition, cannot  yet  be  decided. 

Increased  atmospheric  pressure,  as  noticed  in  caissons,  tun- 
nels, and  mines,  produces  increase  in  frequency  and  depth  of 
respiration,  diminution  in  the  number  of  beats  and  volume  of 
the  pulse,  pallor  of  the  skin,  increase  of  perspiration  (although 
Smith  states  that  this  is  only  apparent  and  due  to  lack  of  evapo- 
ration from  the  surface),  increased  appetite,  and  more  abundant 
excretion  from  the  kidneys. 

Among  the  distinctly  pathological  effects  of  increased  at- 
mospheric pressure  are  rupture  of  the  drum  of  the.  ear,  pain  in 
the  frontal  and  maxillary  sinuses,  neuralgic  pains,  nausea,  some- 
times vomiting  and  local  paralyses.  Dr.  A.  H.  Smith1  defines 
this  collection  of  symptoms  as  "  The  Caisson  Disease,"  and  gives 
the  following  summary  of  its  characteristic  features : — 

"A  disease  depending  upon  increased  atmospheric  pressure, 
but  always  developed  after  the  pressure  is  removed.     It  is  char- 

1  The  Physiological,  Pathological,  and  Therapeutical  Effects  of  Compressed  Air,  p.  47. 
Detroit,  1886. 


INFLUENCE    OF   CHANGES   OF    ATMOSPHERIC    PRESSURE.  13 

acterized  by  extreme  pain  in  one  or  more  of  the  extremities,  and 
sometimes  in  the  trunk,  and  which  may  or  may  not  be  associated 
with  epigastric  pain  and  vomiting.  In  some  cases  the  pain  is 
accompanied  by  paralysis  more  or  less  complete,  which  may  be 
general  or  local,  but  is  most  frequently  confined  to  the  lower 
half  of  the  body.  Cerebral  symptoms,  such  as  headache  and 
vertigo,  are  sometimes  present.  The  above  symptoms  are  con- 
nected, at  least  in  the  fatal  cases,  with  congestion  of  the  brain 
and  spinal  cord,  often  resulting  in  serous  or  sanguineous  effu- 
sion, and  with  congestion  of  most  of  the  abdominal  viscera." 


INFLUENCE    OF   CHANGES   OF   TEMPERATURE    ON   HEALTH. 

Many  of  the  derangements  of  health  ascribed  to  high  tem- 
perature are  to  a  considerable  degree  due  to  other  factors,  promi- 
nent among  which  are  high  humidity,  intemperance,  overwork, 
and  overcrowding.  There  can  be  little  doubt,  however,  that  the 
importance  of  the  high  temperature  itself  can  hardly  be  over- 
rated. It  has  been  generally  accepted  heretofore  that  a  high 
temperature,  together  with  a  high  relative  humidity,  is  most 
likely  to  be  followed  by  sun-stroke.  A  careful  comparison  in  a 
series  of  deaths  from  sun-stroke  in  the  city  of  Cincinnati  in  the 
summer  of  1881  shows,  however,  conclusively  that  a  very  high 
mean  temperature  with  a  low  relative  humidity  is  more  liable  to 
be  followed  by  sun-stroke  than  the  high  temperature  when  ac- 
companied by  a  high  humidity.  The  same  series  of  observa- 
tions also  shows  that  the  number  of  deaths  was  greater  on  clear 
days  than  on  cloudy  or  partly  cloudy  days.1  A  corroboration 
of  this  result  is  found  in  the  fact  that  sun-strokes  very  rarely 
occur  on  shipboard,  at  sea,  where  the  relative  humidity  is 
always  high. 

The  direct  influence  of  the  sun's  rays  upon  the  skin  pro- 
duces at  times  an  erythematous  affection  which  may  run  into  a 

1  The  Sun-stroke  Epidemic  of  Cincinnati,  0.,  during  the  Summer  of  1881.  A.  J.  Miles, 
Public  Health,  vol.  vii,  pp.  293-304. 


14  TEXT-BOOK   OF   HYGIENE. 

dermatitis  if  the  insolation  is  prolonged.  Artificial  heat  may 
produce  similar  effects. 

Diarrhceal  diseases,  both  of  adults  and  children,  are  much 
more  frequent  during  hot  than  cold  weather  (and  in  hot  than  in 
cold  climates),  but  it  is  probable  that  other  factors  aid  in  the 
production  of  these  diseases  besides  the  high  temperature. 

Certain  epidemic  diseases  are  likewise  more  frequent  in,  or 
exclusively  confined  to,  hot  climates.  These  are  cholera,  yellow 
fever,  and  epidemic  dysentery.  Elephantiasis  and  the  prevalence 
of  certain  skin  diseases  seem  also  to  have  some  connection  with 
a  constantly  high  external  temperature.  The  intimate  relation 
between  cause  and  effect  is  not  clearly  understood,  although  the 
belief  is  current  that  the  origin  and  spread  of  such  diseases 
depend  upon  the  development  of  various  parasitic  organisms. 

Regarding  the  morbific  effects  of  continued  high  tempera- 
tures, it  is  probable  that  an  appropriate  mode  of  life,  proper 
diet,  and  suitable  clothing  would  avert  many  of  the  bad  conse- 
quences. Nevertheless,  the  fact  remains  that  certain  tropical  or 
hot-weather  diseases  must  be  considered  as  primarily  dependent 
upon  high  temperature,  although  the  pathological  effects  may  be 
due  to  an  intermediate  factor.  It  is  not  improbable  that  micro- 
organisms will  be  found  to  explain  yellow  fever,  cholera  infan- 
tum, and  tropical  dysentery.  Cholera  has  already  been  shown 
to  depend  upon  a  pathogenic  organism.  In  this  case  the  high 
temperature  is  one  of  the  associate  but  none  the  less  indispens- 
able factors  in  the  production  of  the  disease. 

Extreme  low  temperature,  as  observed  in  the  arctic  regions, 
seems  to  produce  a  progressive  deterioration  of  the  blood 
(anaemia),  in  consequence  of  which  most  natives  of  temperate 
regions  who  are  compelled  to  remain  in  the  far  north  longer 
than  two  winters  succumb  to  various  uremic  diseases,  scurvy  be- 
ing the  most  prominent.  It  is  not  improbable,  however,  that  the 
dietary  furnished  is  responsible  for  a  large  share  of  the  evil 
effects  ascribed  to  cold.  The  absence  of  sunlight  for  a  consider- 
able part  of  the  winter  season  may  also  have  much  to  do  with 


INFLUENCE    OF    CHANGES    OF    TEMPERATURE    ON   HEALTH.        15 

the  bad  influences  for  which  the  low  temperature  is  held 
responsible. 

Among  the  acute  effects  of  great  cold,  frost-bite  is  the  most 
frequent  as  well  as  the  most  serious.  Loss  of  portions  of  the 
nose,  or  ears,  or  even  of  entire  members  are  not  infrequent 
results  of  frost-bite. 

In  the  arctic  regions  one  of  the  most  annoying  affections 
which  the  traveler  has  to  contend  against  is  snow-blindness,  a 
severe  ophthalmia  produced  by  the  glare  of  the  snow.  Neutral 
tinted  glass  goggles  should  be  worn  as  a  preventive.1 

Dr.  Henry  B.  Baker2  has  placed  upon  record  a  large  mass 
of  observations  which  appear  to  indicate  that  most  of  the  acute 
diseases  of  the  respiratory  organs  are  caused  by  a  low  tempera- 
ture in  conjunction  with  a  low  absolute  humidity.  Dr.  Baker 
furnishes  numerous  diagrams,  which  seem  to  demonstrate  that 
the  curves  for  influenza,  tonsillitis,  croup,  bronchitis,  and  pneu- 
monia are  in  general  outlines  all  practically  the  same,  and  that 
they  follow  the  curve  for  atmospheric  temperature  with  surpris- 
ing closeness,  rising  after  the  temperature  falls  and  falling  after 
the  temperature  rises.  He  claims  that  this  sameness  indicates 
that  the  controlling  cause  is  one  and  the  same  for  all  of  these 
diseases,  and  that,  directly  or  indirectly,  the  atmospheric  tem- 
perature is  that  cause.  They  are  diseases  of  the  air-passages, 
and  may  be  supposed  to  be  influenced  or  controlled  by  the  at- 
mosphere which  passes  through  them.  Although  the  curves  are 
all  similar,  yet  their  differences  still  further  support  his  view, 
because  the  order  of  succession  of  the  several  diseases  is  such 
as  would  be  expected  if  caused  in  the  manner  which  he  sup- 
poses. Thus  croup  and  influenza  precede  in  time  bronchitis 
and  pneumonia ;  the  curve  for  bronchitis  shows  that  disease  to 
respond  quicker  than  does  pneumonia  to  the  rise  and  fall  of  the 


1  See  Payer's  Narrative  of  the  Austrian  Arctic  Voyage  of  1872-74,  pp.  250-3  and  317,  for  an 
account  of  the  effects  of  cold  on  the  organism,  and  on  the  best  prophylactic  measures  to  toe 
adopted.  The  Report  of  the  Surgeon-General  of  the  U.  S.  Navy  for  1880  also  contains  (pp.  350-8) 
a  valuable  memorandum  by  Ex-Surgeon-General  Philip  S.  Wales,  on  Arctic  Hygiene. 

2  Trans.  Ninth  International  Med.  Congress,  voL  v. 


16  TEXT-BOOK   OF   HYGIENE. 

temperature.  He  suggests  that  the  explanation  of  the  causa- 
tion of  these  diseases  has  not  been  grasped  before  because  one 
of  the  principal  facts  has  not  been  apprehended,  namely,  the 
fact  that  cold  air  is  always  dry  air  ;  on  the  contrary,  it  has  been 
generally  stated  that  when  these  diseases  occur  the  air  is  cold 
and  damp.  He  explains  that  while  the  cold  air  is  damp  rela- 
tively it  is  always  dry  absolutely,  and  he  thinks  that  its  bad 
effects  on  the  air-passages  are  mainly  through  its  drying  effects, 
wThich  can  best  be  appreciated  by  reflecting  that  each  cubic  foot 
of  air  inhaled  at  the  temperature  of  zero,  F.  [ —  17.8°  C],  can 
contain  only  \  grain  of  vapor  [1.33  grammes  per  cubic  metre], 
while  when  exhaled  it  is  nearly  saturated  at  a  temperature 
of  about  98°  F.  [36.5°  C],  and  therefore  contains  about  18 J 
grains  of  vapor  [about  43  grammes  per  cubic  metre],  about  18 
grains  of  which  have  been  abstracted  from  the  air-passages. 
Thus  cold  air  falling  upon  susceptible  surfaces  tends  to  produce 
an  abnormal  dryness  which  may  be  followed  by  irritation  and 
suppuration.  He  claims  that  coryza  is  sometimes  so  caused. 
Under  some  conditions  the  nasal  surfaces  are  not  susceptible  to 
drying,  the  fluids  being  supplied  in  increased  quantity  to  meet 
the  increased  demand  made  by  the  inhalation  of  cold  air.  In 
that  case  an  unusual  evaporation  of  the  fluid  leaves  behind  an 
unusual  quantity  of  non-volatile  salts  of  the  blood,  such  as 
sodium  chloride,  and  an  unusual  irritation  results ;  he  thinks 
influenza  is  the  name  commonly  given  to  this  condition.  The 
effects  which  the  inhalation  of  cold  air  has  on  the  bronchial 
surfaces  depend  greatly  upon  how  the  upper  air-passages  have 
responded  to  the  increased  demand  for  fluids ;  because,  if  they  do 
not  supply  the  moisture  it  must  be  supplied  by  the  bronchial 
surfaces,  in  which  case  bronchitis  results.  Finally,  if  the  de- 
mands for  moisture  made  by  cold  air  are  not  met  until  the  air- 
cells  are  reached  pneumonia  is  produced. 

These  claims  are  partly  supported  and  partly  opposed  by 
an  elaborate  paper  by  Dr.  J.  W.  Moore.1     According  to  the 

1  The  Seasonal  Prevalence  of  Pneumonic  Fever,  Trans.  Ninth  Internat.  Congress,  vol.  v. 


INFLUENCE    OF    CHANGES    OF    TEMPERATURE   ON    HEALTH.        17 

statistics  furnished  by  this  writer,  bronchitis  and  pneumonia 
show  a  remarkable  contrast  as  to  seasonal  prevalence.  The  sta- 
tistics of  London  and  Dublin  agree  very  closely  upon  this  point. 
Bronchitis  falls  to  a  very  low  ebb  in  the  third  or  summer  quarter 
of  the  year  (July  to  September,  inclusive),  when  only  12  per 
cent,  of  the  deaths  annually  caused  by  this  disease  take  place 
in  Dublin  and  only  11  per  cent,  in  London.  In  the  last  or 
fourth  quarter  (October  to  December,  inclusive)  the  percentage 
of  deaths  from  bronchitis  rises  to  27  in  Dublin  and  30  in  London. 
The  maximal  mortality  occurs  in  the  first  quarter  (January  to 
March,  inclusive),  when  it  is  38  per  cent,  in  both  London  and 
Dublin.  In  the  second  or  spring  quarter  (April  to  June,  inclu- 
sive) the  bronchitic  deaths  decline  to  23  per  cent,  in  Dublin  and 
21  per  cent,  in  London. 

The  mortality  from  pneumonic  fever  is  differently  distrib- 
uted throughout  the  year.  In  the  summer  quarter  more  than 
14  per  cent,  of  the  annual  deaths  referable  to  the  disease  are 
recorded  in  Dublin  and  more  than  15  per  cent,  in  London. 
In  the  first  quarter  the  figures  are — London,  31  per  cent; 
Dublin,  31  per  cent.  In  the  second  quarter  they  are — London, 
26  per  cent. ;  Dublin,  30  per  cent.  In  the  fourth  quarter  they 
are — London,  27  per  cent. ;  Dublin,  24  per  cent. 

It  therefore  appears  that  the  prevalence  and  fatality  of  pneu- 
monic fever  from  season  to  season  do  not  correspond  with  the 
seasonal  prevalence  and  fatality  of  bronchitis.  The  latter  dis- 
ease increases  and  kills  in  direct  relation  to  the  setting  in  of  cold 
weather ;  it  subsides  in  prevalence  and  fatality  with  the  advance 
of  spring  and  the  advent  of  summer.  Pneumonic  fever,  on  the 
other  hand,  increases  less  quickly  in  winter  and  remains  more 
prevalent  in  spring  than  bronchitis ;  its  maximal  incidence  coin- 
cides with  the  dry,  harsh  winds  and  hot  sunshine  of  spring, 
when  the  diurnal  range  of  temperature  also  is  extreme. 

Dr.  Moore  believes  that  acute  bronchitis  is  produced  directly 
by  the  influence  of  low  temperature,  while  pneumonia  requires 
an  additional  cause,  which  he  supposes  to  be  a  specific  micro- 
organism. 2 


18  TEXT-BOOK   OF    HYGIENE. 

HUMIDITY   OF   THE   ATMOSPHERE    AS    CONNECTED   WITH    CHANGES    IN 

HEALTH. 

The  propagation  of  certain  acnte  infectious  diseases  is  be- 
lieved to  be  due  to  a  high  relative  humidity.  There  can  be  no 
longer  any  doubt  that  a  very  humid  soil  and  air,  especially  if 
connected  with  a  variable  temperature,  are  almost  constant 
factors  in  the  production  of  pulmonary  phthisis.  Recent  experi- 
ence in  this  country  and  abroad  has  shown  that  the  high  plateaus 
and  mountains,  far  inland,  where  the  soil  is  dry  and  the  relative 
humidity  of  the  air  low,  are  the  best  resorts  for  consumptives. 

Of  the  effects  of  excessively  dry  air  on  health  little  definite 
is  known.  It  seems  probable,  however,  that  catarrhal  affections 
of  the  respiratory  mucous  membrane  are  more  frequent  in  a  dry 
than  in  a  humid  climate.1 

THE   SANITARY   RELATIONS    OF    AIR-CURRENTS. 

Primarily,  winds  or  air-currents  may  be  considered  as  favor- 
able to  health.  By  the  agitation  of  the  air  ventilation  is  secured, 
foul  air  removed  from  insanitary  places,  and  diluted  by  ad- 
mixture of  purer  air.  But  air-currents  may  also  be  regarded  as 
either  directly  or  indirectly  unfavorably  influencing  health. 
Vertical  currents  rising  from  the  ground  may  carry  morbific 
germs  or  viruses  and  give  rise  to  disease.  Horizontal  currents 
or  winds  proper  may  also  be  the  direct  or  indirect  cause  of  de- 
rangements of  health. 

Full  credit  is  given  by  the  public  to  cold  winds  and  draughts 
in  producing  catarrhs  and  rheumatic  pains.  The  progression  of 
certain  infectious  diseases,  especially  malaria,  is  believed  with 
good  reason  to  stand  in  a  definite  relation  with  the  direction  of 
the  wind. 

Certain  local  winds  are  known  to  have  a  deleterious  effect 
upon  living  beings,  especially  when  the  latter  are  in  bad  health. 
Among  these  winds  is  the  mistral,  a  cold,  dry,  parching  north- 

1  See  ante. 


SANITARY    RELATIONS   OF   AIR-CURRENTS.  19 

west  wind  which  blows  along  the  Gulf  of  Lyons.  It  brings  on 
rheumatism  and  muscular  pains,  and  is  said  to  excite  pleurisy 
and  pneumonia  and  to  act  unfavorably  upon  consumptives. 

The  bora  is  a  cold,  dry  wind  coming  down  from  the  Alps 
and  continuing  across  the  Adriatic. 

The  Texan  northers  are  well  known  in  the  southwestern 
part  of  the  United  States.  They  are  extremely  dry,  and  are 
often  accompanied  by  a  sudden  fall  of  temperature.  Changes 
of  28°  C.  (50°  F.)  within  twelve  hours  are  not  infrequent  in 
Western  and  Central  Texas.  Both  man  and  beast  suffer  in- 
tensely from  the  cold,  parching  character  of  the  wind. 

The  sirocco  of  Northern  Africa,  Sicily,  and  Southern  Italy 
has  a  world-wide  notoriety  for  its  depressing  effect  upon  human 
energy.  The  harmattan  is  equally  noted  on  the  west  coast  of 
Africa.  It  is  hot  and  dry,  while  in  Southern  Europe  the  sirocco 
is  hot  and  moist. 

The  simoon  is  a  hot,  scorching  wind  of  India,  and  is  said 
to  be  deadly  in  its  effects  upon  vegetation  and  extremely  dele- 
terious to  men  and  animals  who  are  encountered  by  it.  In 
Australia  and  South  Africa  hot  winds  are  said  to  occur  which 
completely  destroy  vegetable  life  in  their  track,  and  are  often 
unwholesome  in  their  effects  upon  animal  life. 

The  evil  reputation  of  the  Alpine  John  is  very  well  known, 
and  neither  native  nor  traveler  is  anxious  to  encounter  it.  It  is 
warm  and  dry. 

With  reference  to  the  influence  of  electrical  conditions  of 
the  atmosphere  upon  health,  no  observations  have  been  made 
which  justify  definite  conclusions.1 

Mr.  Alexander  Buchan  and  Dr.  Arthur  Mitchell  have 
analyzed  the  influence  of  the  weather  and  season  upon  the 

1  Dr.  S.  Weir  Mitchell  has  shown,  from  the  record  of  the  case  of  Captain  Catlin,  U.  S.  A 
(American  Journal  Med.  Sci.,  April,  1877,  and  N.  Y.  Med.  Jour.,  August  25  and  September  1, 1883). 
that  attacks  of  neuralgia — in  this  case,  at  all  events — accompanied  the  progress  of  storms  across 
the  continent.  Also,  that  the  periods  of  maximum  pain  occurred  with  a  high  but  falling  barom- 
eter and  increasing  absolute  humidity.  There  seems  also  to  be  some  relation  in  this  case  between 
the  maximum  pain  and  the  maximum  magnetic  force  as  shown  by  the  declinometer.  Dr. 
Mitchell's  papers  are  among  the  most  valuable  positive  contributions  to  hygienic  meteorology, 
and  deserve  careful  study. 


20  TEXT-BOOK   OF    HYGIENE. 

causation  of  disease,  or,  rather,  upon  the  mortality  from  various 
diseases.1  Taking  the  records  of  the  city  of  New  York  from 
1871  to  1877,  it  appears  "that  the  maximum  number  of  deaths 
from  small-pox  occurred  in  May,  the  minimum  in  September. 
From  measles  there  were  two  annual  maxima  and  minima,  the 
greater  in  July  and  September  and  the  smaller  in  February  and 
April.  From  scarlet  fever  the  maximum  was  in  April,  the  mini- 
mum in  September.  From  typhoid  fever  the  maximum  was 
from  August  to  November,  the  minimum  almost  equally  distrib- 
uted throughout  the  rest  of  the  year ;  from  diarrhoea,  the  maxi- 
mum in  July  and  August,  the  minimum  from  December  to 
March ;  from  diphtheria,  the  maximum  in  December,  the  mini- 
mum in  August ; 2  from  whooping-cough,  maximum  in  Septem- 
ber and  February,  minimum  in  November  and  June ;  for  croup 
the  curves  agree  pretty  closely  with  the  diphtheria  curves ;  from 
phthisis,  the  maximum  in  March,  minimum  in  June. 

The  following  charts,  reproduced  by  permission  of  the 
Massachusetts  State  Board  of  Health  from  the  report  of  that 
body  for  1888,  show  an  almost  identical  movement  of  the 
mortality  from  different  diseases  throughout  the  year.  They 
exhibit  the  reported  mortality  for  1888  and  also  for  the  six  years 
from  1883  to  1888. 

From  suicide,  curiously,  the  greater  number  of  deaths  occurs 
in  May,  the  smallest  in  February.  This  is  contrary  to  the  usual 
supposition  that  gloomy  weather  predisposes  to  suicide.  The  six 
summer  months — from  April  to  September — show  a  much  larger 
number  of  self-murders  than  the  remaining  half-year.  In  eleven 
years,  ending  1880,  there  were  1521  cases  of  self-destruction  in 
New  York.  Of  these  341  occurred  during  January,  February, 
and  March;  417  during  April,  May,  and  June;  412  during 
July,  August,  and  September;  and  351  during  the  last  three 
months  of  the  year.    In  Philadelphia,  the  results  of  examination 

1  Journal  Scottish  Meteorological  Society,  1875-78.  (Abstract  in  Richardson's  Prevent- 
ive Medicine,  p.  533  et  seq.    Philadelphia,  1884.) 

2  See  paper  on  the  Relation  of  Weather  to  Mortality  from  Diphtheria  in  Baltimore, 
by  Richard  Henry  Thomas,  in  Trans.  Med.  and  Chir.  Faculty  of  Maryland,  1883. 


INFLUENCE    OF    SEASON    UPON    MORTALITY. 


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26  TEXT-BOOK    OF    HYGIENE. 

of  the  statistics  of  suicide  for  ten  years  are  almost  exactly 
similar.  Out  of  636  cases  of  suicide,  78  occurred  in  May,  71  in 
August,  57  in  December,  54  each  in  October,  July,  and  April, 
52  in  June,  49  in  November,  44  each  in  December  and  Feb- 
ruary, 43  in  March,  and  36  in  January.1  Dr.  Lee  is  led  to  be- 
lieve that  "  a  low  barometric  pressure,  accompanied  by  a  high 
thermometric  registry,  with  sudden  fluctuations  from  a  low  to  a 
high  temperature,  together  with  much  moisture  and  prevailing 
southwest  winds,  might  somewhat  account  for  the  frequency  of 
self-murder  in  the  spring  and  summer  months." 

THE    SANITARY    RELATIONS    OF    CHANGES     IN    COMPOSITION    AND    OF 
IMPURITIES   IN    THE    AIR. 

The  average  proportion  of  carbon  dioxide  in  the  atmosphere 
is  from  3  to  4  parts  in  10,000.  Pettenkofer2  places  the  maxi- 
mum limit  of  carbon  dioxide  allowable  in  the  air  of  dwellings 
at  7  parts  in  10,000.  It  is  probable  that  this  limit  is  very  fre- 
quently exceeded  without  serious  consequences  to  health,  if  the 
air  is  not  at  the  same  time  polluted  by  organic  impurities,  the 
products  of  respiration.  Prof.  William  Ripley  Nichols  found 
the  air  in  a  school-room  in  Boston  to  contain  eight  times  the 
normal  proportion  of  carbon  dioxide,  while  Pettenkofer  found, 
also  in  a  school-room,  after  the  same  had  been  occupied  two 
hours,  eighteen  times  the  normal  proportion,  or  72  parts  in 
10,000.3  While  such  an  excess  of  this  poisonous  gas  must 
unquestionably  have  an  unfavorable  influence  upon  health,  it  is 
probable  that  the  most  serious  effects  are  due  to  the  coincident 
diminution  of  oxygen  and  the  pollution  of  the  air  by  the  prod- 
ucts of  respiration  which  necessarily  take  place  during  respira- 
tion. Carbon  dioxide  alone  may  be  present  in  the  air  to  a  much 
greater  extent  than  above  mentioned  without  causing  any  appre- 
ciable inconvenience.     In  the  air  of  soda-water  manufactories 

1  Suicide  in  the  City  and  County  of  Philadelphia  during  a  Decade,  1872  to  1881,  inclusive, 
by  John  G.  Lee,  Trans.  Am.  Med.  Asso.,  vol.  xxxiii,  p.  425. 

2  Quoted  in  Buck's  Hygiene  and  Public  Health,  vol.  i,  p.  615. 

3  See  table  in  Buck's  Hygiene  and  Public  Health,  vol.  i,  p.  612. 


SANITARY    RELATIONS    OF    IMPURITIES    IN    THE    AIR.  27 

there  is  frequently  as  large  a  proportion  as  2  per  cent,  of  this 
gas  present  without  producing  any  ill  effects  upon  those  breathing 
such  an  atmosphere. 

The  amount  of  carbon  dioxide  in  the  atmosphere  is  greatest 
at  night.  It  is  also  greater  very  near  the  ground  than  at  a  dis- 
tance of  several  feet  above  it.  As  carbon  dioxide  is  absorbed 
by  the  leaves  of  plants  during  the  day-time,  but  given  off  at 
night,  the  difference  may  partly  be  thus  accounted  for.  Accord- 
ing to  Fodor,1  the  source  of  a  large  proportion  of  the  carbon 
dioxide  in  the  air  is  the  decomposition  going  on  in  the  soil. 
This  accounts  for  the  larger  percentage  of  carbon  dioxide  near 
the  ground.  This  would  also  explain  the  variation  of  the  pro- 
portion of  carbon  dioxide  in  the  air  under  different  meteoro- 
logical conditions.  For  example,  it  is  found  that  during  rainy 
weather  the  carbon  dioxide  in  the  air  is  diminished.  This  is 
accounted  for  partly  by  the  absorption  of  the  carbon  dioxide 
by  the  saturated  ground,  while  at  the  same  time  the  porosity 
of  the  soil  is  diminished  and  the  escape  of  the  ground-air 
prevented. 

Mr.  R.  Angus  Smith  made  a  number  of  experiments  upon 
himself  to  determine  the  effects  of  an  atmosphere  gradually 
becoming  charged  with  the  products  of  respiration  and  per- 
spiration. His  experiments  were  conducted  in  a  leaden  cham- 
ber holding  5  cubic  metres  of  air.  This  air  was  not  changed 
during  the  experiment.  After  remaining  for  an  hour  in  this 
chamber,  an  unpleasant  odor  of  organic  matter  was  perceptible 
on  moving  about.  The  air,  when  agitated,  felt  soft,  owing, 
doubtless,  to  the  excess  of  moisture  contained  in  it.  The  air 
soon  became  very  foul,  and,  although  not  producing  any  dis- 
comfort, the  experimenter  states  that  escape  from  it  produced  a 
feeling  of  extreme  pleasure,  like  "  that  which  one  has  when 
walking  home  on  a  fine  evening  after  leaving  a  room  which  has 
been  crowded."  2 

1  Hygienisclie  Untersucliungen  ueber  Luft,  Boden  und  Wasser,  Braunschweig.  1882, 
2te  Abth. 

2  Air  and  "Rain,  p.  138. 


28  TEXT-BOOK   OF    HYGIENE. 

Hammond  1  confined  a  mouse  in  a  large  jar  in  which  were 
suspended  several  large  sponges  saturated  with  baryta  water,  to 
remove  the  carbon  dioxide  as  rapidly  as  formed.  Fresh  air  was 
supplied  as  fast  as  required.  The  aqueous  vapor  exhaled  was 
absorbed  by  calcium  chloride.  The  mouse  died  in  forty-five 
minutes,  evidently  from  the  effect  of  the  organic  matter  in  the 
air  of  the  jar.  The  presence  of  this  organic  matter  was  demon- 
strated by  passing  the  air  through  a  solution  of  potassium  per- 
manganate. 

The  horrible  story  of  the  "black  hole"  of  Calcutta  is 
familiar  to  every  one.  Of  146  prisoners  confined  in  a  dark  cell 
at  night,  23  were  found  alive  in  the  morning.  Among  the  sur- 
vivors a  fatal  form  of  typhus  fever  broke  out,  which  carried  off 
nearly  all  of  them.  After  the  battle  of  Austerlitz  300  prisoners 
were  crowded  in  a  prison ;  260  died  in  a  short  time  from  inhal- 
ing the  poisoned  air.  Numerous  other  similar  examples  of  the 
effects  of  polluted  air  are  recorded. 

Usually  the  effects  of  foul  air  are  not  so  sudden  and  strik- 
ing. In  most  instances,  especially  where  the  pollution  has  not 
reached  a  high  degree,  there  simply  results  a  general  deficiency 
of  nutrition,  which  manifests  itself  in  anaemia,  loss  of  vigor  of 
bodv  and  mind,  and  a  gradual  diminution  of  resistance  to 
disease. 

It  seems  to  be  beyond  question  that  persons  who  are  con- 
stantly compelled  to  inhale  impure  air,  especially  if  combined 
with  an  improper  position  of  the  bodyr  or  lack  of  sufficient  or 
appropriate  food,  furnish  a  very  large  percentage  of  chronic  pul- 
monary affections.  Phthisical  patients,  in  the  overwhelming 
majority  of  cases,  are  drawn  from  the  classes  whose  occupations 
keep  them  confined  in  close  rooms.  Want  of  exercise  and  of 
good  food  doubtless  aid  in  the  development  of  the  lung  disease. 
Formerly,  when  less  attention  was  paid  to  the  proper  construc- 
tion and  ventilation  of  barracks  and  prisons,  the  mortality  from 

1  A  Treatise  on  Hygiene,  -with  Special  Reference  to  the  Military  Service,  by  William  A. 
Hammond,  M.D.,  Surgeon-General  U.  S.  Army,  p.  170.    Philadelphia,  1863. 


SANITARY    RELATIONS    OF    IMPURITIES   IN   THE    AIR.  29 

phthisis  among  soldiers  and  criminals  was  much  greater  than  it 
is  now.  In  animals  kept  closely  confined  the  same  disease  claims 
a  large  share  in  the  mortality. 

Near  the  end  of  the  last  century  over  one-third  of  the  in- 
fants born  in  the  old  Dublin  Lying-in  Hospital  died  of  epidemic 
diseases.  After  the  adoption  of  an  improved  system  of  ventila- 
tion the  mortality  fell  to  about  one-tenth  of  what  it  had  pre- 
viously been.  To  illustrate  the  effect  of  similar  conditions  upon 
the  health  of  domestic  animals,  the  following  instance  is  cited : 
Upward  of  thirty  years  ago  a  severe  epidemic  of  influenza  in 
horses  appeared  in  Boston.  At  the  instigation  of  Dr.  H.  I. 
Bowditch,  every  stable  in  the  city  was  inspected,  and  classified 
as  "  excellent,"  "  imperfect,"  or  "  wholly  unfit,"  in  respect  to 
warmth,  dryness,  light,  ventilation,  and  cleanliness.  It  was 
found  that  in  the  first  class  fewer  horses  were  attacked  and  the 
disease  was  milder,  while  in  the  third  class  every  horse  was 
attacked  and  the  more  severe  and  fatal  cases  occurred. 

Carbon  monoxide  is  a  very  dangerous  impurity  often 
present  in  the  air  of  living-rooms.  Being  an  ingredient  of 
illuminating  gas,  as  well  as  the  so-called  coal-gas,  which  so 
frequently  escapes  from  stoves  and  furnaces,  its  dangerous  char- 
acter becomes  apparent.  Many  persons  die  every  year  in  this 
country  from  the  inhalation  of  illuminating  gas.  People  un- 
acquainted with  the  mechanism  of  the  gas-fixtures  frequently 
blow  out  the  light  instead  of  cutting  off  the  supply  of  gas  by 
turning  the  stop-cock.  It  is  also  a  prevailing  custom  to  keep 
the  light  burning  "  low  "  during  the  night.  Any  considerable 
variation  of  pressure  in  the  pipes,  or  sudden  draught,  may  put 
out  the  light  and  permit  the  gas  to  escape  into  the  room,  with 
fatal  effect.     Leaks  in  pipes  or  fixtures  may  have  the  same  results. 

Coal-,  coke-,  or  charcoal-  fires  may  produce  serious  or  fatal 
poisoning  if  the  gas,  which  contains  a  large  proportion  of  car- 
bon  monoxide,  is    permitted   to   escape   into  the   room.1      In 

1  See  paper  by  Dr.  John  Graham  in  Transactions  of  Philadelphia  College  of  Physicians 
for  1885. 


30  TEXT-BOOK   OF    HYGIENE. 

certain  parts  of  Europe,  notably  in  France,  the  inhalation  of  the 
fumes  of  a  charcoal  fire  is  a  favorite  method  of  committing 
suicide. 

The  gas  which  sometimes  escapes  from  the  stove  when  coal 
is  burning  has  the  following  composition  : — 


Carbon  dioxide, . 
Carbon  monoxide, 
Oxygen,      , 
Nitrogen,    . 


6.75  per  cent. 
1.34       " 

13.19       " 
79.72       " 


Sulphuretted  and  carburetted  hydrogen  are  not  infrequently 
present  in  the  air,  especially  about  cess-pools  and  in  mines  and 
certain  manufacturing  establishments.  Sulphuretted  hydrogen 
is  generally  considered  to  be  a  violent  poison,  but  there  is  no 
evidence  that  it  is  so  unless  oxygen  is  excluded. 

Carburetted  hydrogen  is  the  so-called  "fire-damp"  of 
mines,  which  is  so  often  the  cause  of  fatal  explosions.  Its  in- 
halation does  not  seem  to  be  especially  noxious.  It  will  be 
more  fully  referred  to  in  a  succeeding  chapter. 

Variations  in  the  proportion  of  ammonia  present  in  the  air 
are  frequent.  Its  presence  is  an  indication  of  organic  decom- 
position in  the  vicinity,  but  nothing  is  known  of  the  influence 
of  the  gas  itself  upon  health,  in  the  proportion  in  which  it  is 
ever  found  in  the  atmosphere. 

SEWER-AIR. 

Sewer-air,  or  sewer-gas,  as  it  is  often  improperly  called,  is 
a  variable  mixture  of  a  number  of  gases,  vapors,  atmospheric 
air,  and  solid  particles,  and  is  derived  from  the  decomposition  of 
the  animal  and  vegetable  contents  of  sewers.  A  number  of 
analyses  by  different  chemists  have  shown  that  the  composition 
of  sewer-air  is  extremely  variable.  The  most  important  com- 
ponents, in  addition  to  the  constituents  of  atmospheric  air,  are : 
Carbon  dioxide,  ammonia,  sulphuretted  hydrogen,  and  a  number 
of  volatile  organic  compounds,  which  give  to  sewage  its  peculiar 
odor,  but  which  are  present  in  such  small  quantity  as  to  prevent 


SEWER- AIR.  31 

accurate  determination  by  chemical  means.  Sewer-air  may  also 
contain  particulate  bodies,  bacteria,  and  other  microscopic  or- 
ganisms, which  are  supposed  by  many  to  be  the  active  causes 
of  infectious  diseases.  Some  recent  researches  by  Carnelly  and 
Haldane  have  shown  that  sewer-air  usually  contains  a  less 
number  of  micro-organisms  than  the  external  air  of  cities.  The 
proportion  of  carbon  dioxide  found  was  also  much  less  than  was 
expected.  When  the  contents  of  sewers  remain  in  these  re- 
ceptacles or  conduits  long  enough  to  undergo  decomposition, 
sewer-air  is  always  present.  It  is  believed  by  some  physicians 
and  sanitarians  that  sewer-air  is  the  direct  cause  of  such  diseases 
as  typhoid  fever,  scarlet  fever,  diphtheria,  and  cholera,  while 
others  hold  the  view  that  the  sewer-air  is  merely  a  favorable 
breeding-place  for  the  germs  of  these  diseases,  and  that  it  thus 
merely  acts  as  a  medium  in  which  the  infective  agent  grows,  re- 
produces itself,  and  is  conveyed  from  place  to  place.  There  is 
no  absolutely  trustworthy  evidence  in  favor  of  either  of  these 
doctrines. 

It  is  hardly  open  to  question,  however,  that  the  continual 
breathing  of  air  polluted  by  emanations  from  sewers  often  pro- 
duces more  or  less  serious  derangements  of  health.  Diarrhoea 
and  other  intestinal  affections,  mild  cases  of  continued  fever,  and 
even  cases  of  undoubted  typhoid  fever  have  been  so  frequently 
noted  in  connection  with  defective  sewerage,  and  the  escape  of 
sewer-air  into  inhabited  rooms,  that  doubt  upon  this  point  is 
hardly  justifiable.  With  regard  to  typhoid  fever,  however,  it  is 
probable  that  the  sewage  in  these  cases  contained  the  particular 
virus  (bacillus  1)  which,  it  is  now  generally  believed,  causes  this 
disease. 

The  effluvia  from  cemeteries,  knackeries,  and  other  places 
where  the  bodies  of  animals  are  undergoing  decomposition,  are 
popularly  regarded  as  deleterious  in  their  effects  upon  health. 
The  evidence  in  favor  of  this  view  is,  however,  very  indefinite. 

Professor  Tyndall   has  shown1  that  even  the  apparently 

1  Essays  on  Floating  Matter  of  the  Air.    New  York,  1882. 


32  TEXT-BOOK    OF   HYGIENE. 

clearest  air  is,  when  in  motion,  constantly  filled  with  innumerable, 
particles  of  dust,  which  are  believed  by  many  to  give  rise  to 
various  forms  of  disease.  The  presence  of  these  particles  can 
be  easily  demonstrated  by  means  of  the  electric  light.  Every 
one  has  observed  these  minute  particles  in  a  bright  ray  of  sun- 
light. Under  ordinary  conditions  these  particles  of  dust  would, 
of  course,  give  rise  to  no  trouble,  but,  if  intermingled  with  these 
dust-specks  there  were  disease  germs, — whether  these  germs  be 
considered  as  living  organisms,  or  as  particles  of  dead  tissue 
from  the  body,- — then  manifestly  the  inhalation  of  such  "dust" 
would  be  dangerous.1 

The  quantity  of  dust  found  in  the  air  of  cities  is  much 
greater  than  in  the  country.  Tissandier  found  that  in  Paris  the 
percentage  of  dust  was  eight  to  twelve  times  greater  than  in  the 
open  country.  One-fourth  to  nearly  one-half  of  this  atmos- 
pheric dust  is  organic,  either  animal  or  vegetable.  Very  recent 
observations  have  shown  that  in  Paris  the  air  contains  nine  or 
ten  times  as  many  bacteria  in  a  given  volume  as  the  air  at  the 
observatory  of  Montsouris,  just  without  the  city.  The  relative 
proportions  of  organic  and  inorganic  particles  vary  as  25  to  15 
in  Paris,  45  to  55  in  Dublin,  and  25  to  15  in  the  open 
country.  The  organic  particles  are  either  particles  of  dead  or- 
ganic matter,  or  minute  organisms.  The  proportion  of  the 
latter  varies  in  different  seasons,  being  least  in  winter  and 
spring,  and  greatest  in  summer  and  autumn.  These  organisms 
are  not  necessarily  pathogenetic,  but  the  conditions  which  favor 
the  proliferation  of  non-pathogenic  bacteria  are  likely  to  promote 
the  development  of  disease-producing  ones  likewise. 

Among  the  pathogenic  micro-organisms  found  in  the  at- 
mosphere are  spores  of  achorion  Schoenleinii,  the  so-called  ma- 
laria bacillus  of  Klebs  and  Tommasi-Crudeli,  and  Fehleisen's 
erysipelas  germ.  It  is  probable,  also,  that  the  bacilli  of  tuber- 
culosis, cholera,  and  typhoid  fever,  and  other  organisms,  at  times 

1  See  Chapter  IX,  on  Industrial  Hygiene,  for  effects  of  inhalation  of  dust  in  various 
industries. 


SEWER-AIR.  33 

undergo  multiplication  in  the  air,  and  that  the  latter  may  be  the 
medium  of  communication  of  these  diseases.  But  it  must  be 
admitted  that  our  knowledge  upon  this  point  is  at  present 
rather  vague  and  unsatisfactory. 

As  regards  the  diseases  that  may  be  produced  by  the  in- 
halation of  pathogenic  organisms  there  can  be  no  doubt  that 
diphtheria,  glanders,  measles,  scarlet  fever,  whooping-cough,  in- 
fectious pneumonia,  and,  above  all,  pulmonary  tuberculosis,  are 
so  caused.  It  is  likewise  probable  that  yellow  fever,  epidemic 
influenza,  cholera,  and  typhoid  fever  may  be  produced  in  this^ 
manner. 

TESTS   FOR   IMPURITIES   IN"   THE    AIR. 

The  sense  of  smell  will  indicate  the  presence  of  sulphu- 
retted hydrogen,  or  of  volatile  organic  matter.  Chemical  tests- 
and  the  microscope  will,  however,  be  necessary  to  determine  the 
presence  of  carbon  dioxide,  carbon  monoxide,  or  suspended 
particulate  matter  in  the  air. 

In  order  to  detect  the  presence  of  carbon  dioxide,  advantage 
is  taken  of  the  affinity  of  this  compound  for  certain  alkalies 
with  which  it  forms  insoluble  compounds.  If  a  stream  of  carbon 
dioxide  gas  is  passed  through  lime-  or  baryta-  water,  an  insoluble- 
carbonate  of  lime  or  baryta  is  instantly  formed,  and  produces  a 
milky  precipitate  in  the  water.  If,  instead  of  passing  a  stream 
of  gas  through  the  liquid,  the  latter  be  agitated  with  air  con- 
taining carbon  dioxide,  a  similar  precipitate  is  produced.  The 
most  exact  method  of  determining  the  amount  of  carbon  dioxide 
in  the  air  is  that  known  as  Pettenkofer's,1  but  it  is  somewhat 
complicated.  A  readier  method  has  been  devised  by  Mr.  Angus 
Smith,  and  is  termed  the  minimetric  test.2  A  series  of  six  Avide- 
mouthed  bottles,  having  a  capacity  respectively  of  450,  350,  300, 
250,  200,  and  150  cubic  centimetres,*  is  fitted  with  clean,  tightly- 

1  Lehrbuch  der  Hygiene,  Nowak.  p.  149. 

2  Op.  eit.,  p.  152. 

3  The  equivalents  in  English  measures  are  14  ounces,  11  ounces,  9J£  ounces,  8  ounces,  &£ 
ounces,  and  4%  ounces. 


34 


TEXT-BOOK   OF   HYGIENE. 


fitting  corks.  The  bottles  are  made  perfectly  clean  and  dry, 
and  15  cubic  centimetres  (3f  drachms)  of  clear,  fresh  lime-  or 
barvta-  water  put  into  the  smallest,  the  cork  replaced,  and  the 
bottle  well  shaken.  If  the  water  becomes  turbid  there  is  at 
least  .16  per  cent.  (16  parts  per  10,000)  of  carbon  dioxide 
in  the  air  treated.  If  only  the  water  in  the  largest  bottle 
becomes  cloudy,  the  proportion  of  carbon  dioxide  is  probably 
less  than  5  parts  in  10,000.  For  the  intermediate  series  of 
bottles  the  amounts  of  carbon  dioxide  necessary  to  produce 
cloudiness  are,  respectively:  For  200  cubic  centi- 
metres of  air,  12  parts  in  10,000;  for  250  cubic 
centimetres,  10  parts;  for  300  cubic  centimetres, 
8  parts;  and  for  350  cubic  centimetres,  7  parts  per 
10,000.  If,  therefore,  a  cloudiness  is  produced  with 
any  of  the  bottles  except  the  largest,  the  amount 
of  carbon  dioxide  present  exceeds  the  standard 
allowable  in  pure  air.  The  test  should  be  frequently 
made,  in  order  to  acquire  familiarity  with  its  use. 
The  same  quantity  of  the  test-liquid  is,  of  course, 
used  in  each  bottle. 

A  simple  and  easily-managed  instrument, 
called  an  "air- tester, "has  been  devised  by  Professor 
Wolpert,  a  distinguished  German  meteorologist.  It 
is  described  as  follows  by  Dr.  S.  W.  Abbott,  who 
first  called  attention  to  its  merits  in  this  country1: 
The  little  instrument  consists  of  a  simple  rubber  bulb 
(A)  of  a  capacity  of  28  cubic  centimetres,  a  glass  outlet-tube  (B) 
with  a  constriction  near  its  extremity  (E).  A  glass  test-tube, 
12  centimetres  in  length  (C)  and  2  millimetres  in  diameter,  has 
a  horizontal  mark  near  the  bottom,  indicating  the  point  to  which 
it  must  be  filled  with  perfectly  clear  lime-water,  to  contain 
3  cubic  centimetres.  The  bottom  of  the  tube  is  whitened  and 
has  a  black  mark  stamped  upon  it  (D).  A  small,  wooden  stand, 
a  brush  or  swab,  a  vial  of  vinegar  for  cleaning  the  tube,  and  a 
bottle  of  clear  lime-water  complete  the  outfit. 

1  Boston  Med.  and  Surg.  Journal. 


^0 

Fig.  2. 
Aie-Testek. 


TESTS   FOR   IMPURITIES   IN   THE    AIR.  35 

In  order  to  use  the  instrument,  the  lime-water  (saturated 
solution)  should  be  poured  into  the  test-tube  till  it  reaches  the 
horizontal  mark.  Press  down  the  bulb  with  the  thumb,  so  as 
to  expel  the  air  within  it  as  completely  as  possible,  and  allow  it 
to  fill  with  the  air  of  the  apartment,  insert  the  small  tube  into 
the  lime-water  nearly  to  the  bottom,  and  again  expel  the  air 
with  moderate  rapidity,  so  that  the  bubbles  may  rise  nearly  to 
the  top  of  the  tube,  but  do  not  overflow,  taking  care  to  continue 
the  pressure  of  the  thumb  till  the  small  tube  is  removed  from 
the  lime-water.  Repeat  this  process  until  the  mark  upon  the 
bottom  of  the  test-tube  is  obscured  by  the  opacity  produced  by 
the  reaction  of  the  carbonic  acid  upon  the  lime-water,  the  observer 
looking  downward  through  the  lime-water  from  the  top  of  the 
test-tube. 

With  very  foul  air  it  is  necessary  to  examine  the  mark  after 
filling  and  discharging  the  bulb  a  few  times  only;  with  good  air, 
it  must  be  filled  twenty-five  times  and  upward. 

The  bulb  represented  in  the  cut  is  made  a  little  larger  than 
the  required  capacity,  since  a  small  amount  of  residual  air 
usually  remains  in  the  bulb  and  cannot  be  expelled  without 
great  care. 

After  each  observation,  the  test-tube  must  be  washed  out 
and  wiped  dry.  If  a  white  incrustation  forms  upon  the  tube,  it 
may  be  easily  removed  with  a  little  vinegar,  after  which  the 
tube  should  be  thoroughly  washed  with  pure  water  and  dried. 

If  the  mark  becomes  obscured  after  filling  the  bulb  ten  or 
fifteen  times  only,  the  air  of  an  apartment  is  unfit  for  continuous 
respiration. 

In  a  sick-chamber  the  air  should  be  so  pure  that  the  tur- 
bidity of  the  lime-water  will  not  render  the  mark  invisible  until 
thirty  or  forty  fillings  are  made. 

The  instrument  should  be  used  by  daylight,  over  a  white 
ground,  as  a  sheet  of  writing-paper,  and  care  should  be  taken 
not  to  vitiate  the  result  by  the  observer's  own  breath. 

The  following  approximate  table  is  taken  from  the  article 


36 


TEXT-BOOK   OF    HYGIENE. 


by  Professor  Wolpert,  the  first  column  representing  the  number 
of  fillings  of  the  bulb,  and  the  second  column  the  parts  per 
10,000  of  carbon  dioxide  in  a  given  sample  of  air: — 


Number  of 

Carbon  Dioxide 

Number  of 

Carbon  Dioxide 

Number  of 

Carbon  Dioxide 

Fillings. 

per  10,000. 

Fillings. 

per  10,000. 

Fillings. 

per  10,000. 

1 

200. 

21 

9.5 

41 

4.9 

2 

100. 

22 

9.1 

42 

4.8 

3 

67. 

23 

8.7 

43 

4.6 

4 

50. 

24 

8.3 

44 

4.5 

5 

40. 

25 

8. 

45 

4.4 

6 

33. 

26 

7.7 

46 

4.3 

1 

29. 

27 

7.4 

47 

4.2 

8 

25. 

28 

7.1 

48 

4.1 

9 

22. 

29 

6.9 

49 

4.1 

10 

20. 

30 

6.6 

50 

4. 

11 

18. 

31 

6.4 

51 

3.9 

12 

16. 

32 

6.3 

52 

3.9 

13 

15. 

33 

6.1 

53 

3.8 

14 

14. 

34 

5.9 

54 

3.7 

15 

13. 

35 

5.7 

55 

3.7 

16 

12.5 

36 

5.5 

56 

3.6 

17 

12. 

37 

5.4 

57 

3.5 

18 

11. 

38 

5.3 

58 

3.5 

19 

10.5 

39 

5.1 

59 

3.4 

20 

70. 

40 

5. 

•    60 

3.3 

Carbon  monoxide  is  detected  by  its  reaction  with  palladium 
chloride,  which  gives  a  black  color  when  brought  in  contact 
with  the  gas.  If  a  strip  of  linen  or  blotting-paper  be  moistened 
with  a  solution  of  the  palladium  chloride  (1  to  500)  and  sus- 
pended in  air  containing  carbon  monoxide,  the  black  color  will 
be  developed.  The  suspected  air  may  also  be  passed  through  a 
solution  of  sodio-chloride  of  palladium,  when  the  liquid  will 
turn  black  if  carbon  monoxide  be  present. 

The  percentage  of  organic  impurity  in  the  air  of  an  occu- 
pied room  (products  of  respiration,  etc.)  is  difficult  to  ascertain 
directly. 

Pettenkofer  has  found,  however,  that  the  proportion  of 
carbon  dioxide  present  is  indirectly  a  measure  of  the  organic 
impurity  from  respiration.1     As  the  determination  of  the  carbon 


TESTS   FOR   IMPURITIES   IN    THE    AIR.  37 

dioxide  is  easy  by  the  minimetric  method  of  Angus  Smith,  or 
the  ready  method  of  Wolpert,  the  extent  to  which  the  air  is 
polluted  by  respiratory  impurities  is  readily  ascertained. 

The  presence  of  organic  and  other  suspended  impurities 
can  be  best  demonstrated  with  a  microscope.  An  objective,  mag- 
nifying upward  of  400  linear  diameters,  and  experience  in  the 
use  of  the  instrument  will  be  needed  to  obtain  correct  results. 
By  moistening  a  glass  slide  with  glycerin  and  exposing  it  in 
the  suspected  air,  a  sufficient  quantity  of  the  suspended  matters 
may  be  collected  in  the  course  of  twenty-four  hours  to  permit- 
some  conclusions  to  be  drawn  from  a  microscopic  examination.2 

A  common  method  of  determining  the  presence  or  absence 
of  a  large  quantity  of  carbon  dioxide,  for  example,  at  the  bottom 
of  a  well  or  privy-vault  is  to  lower  a  lighted  candle  to  the 
bottom.  If  the  light  is  extinguished,  the  air  is  considered  irre- 
spirable ;  but,  if  it  continue  burning  brightly,  the  air  is  believed 
to  be  sufficiently  pure  to  sustain  life.  Sulphuretted  hydrogen 
and  sulphide  of  ammonium  are  sometimes  found  in  privy-vaults, 
and,  although  they  will  not  extinguish  a  light,  they  speedily 
prove  fatal  if  inhaled  in  a  concentrated  form,  and  to  the  exclu- 
sion of  a  sufficiency  of  oxygen.  Cases  have  frequently  occurred 
where  serious  or  fatal  results  ensued  from  the  presence  of  a  dan- 
gerous gas,  which  was  thought  to  be  excluded  by  the  burning 
candle. 

1  Recent  observations  in  this  country  (see  Annual  Reports  of  the  Surgeon-General  of 
the  Navy  for  1879,  pp.  45  and  46,  and  the  same  for  1880,  pp.  31  to  34)  seem  to  throw  some  doubt  upon 
the  entire  reliability  of  this  method  of  determining  the  amount  of  organic  matter  in  the  air 
examined.  Prof.  Ira  Remsen  (Report  National  Board  of  Health,  1879,  p.  77,  and  1880,  p.  308  et 
seq.)  has  shown  the  insufficiency  of  the  chemical  methods  at  present  in  use,  and  points  out  the 
difficulties  of  making  trustworthy  and  satisfactory  determinations  of  organic  matter  in  the  air. 
The  great  technical  difficulties  of  the  various  analytical  processes  render  it  unwise  to  burden 
these  pages  with  a  description  of  them.  Only  expert  chemists  are  qualified  to  make  a  thorough 
air  analysis,  and  the  author  does  not  feel  competent  to  offer  advice  to  them.  Dr.  Cornelius  B. 
Fox's  book  on  "  Sanitary  Examinations  of  Water,  Air,  and  Food,"  and  Fliigge's  "Lehrbuch  der 
Hygienischen  Untersuchungsmethoden"  contain  detailed  descriptions  of  the  best  methods 
employed. 

2  Dr.  G.  M.  Sternberg,  TJ.  S.  A.  (Report  National  Board  of  Health,  1880),  gives  an  ac 
count  of  his  investigations  into  the  suspended  matters  of  the  air.  The  question  is  also  con- 
sidered in  a  practical  manner  by  Surgeons  Kidder  and  Streets,  TJ.  S.  N.,  in  Reports  of  the 
Surgeon-General  of  the  Navy  for  1880  and  1881.  See  also  Bacteria,  Sternberg  and  Magnin, 
2d  ed.,  p.  197. 

3  See  a  case  reported  in  Philadelphia  Medical  Times,  October  21, 1882. 


38  TEXT-BOOK   OF   HYGIENE. 

It  is  advisable  in  all  cases  to  exhaust  the  stagnant  air  in 
old  wells  and  privy-vaults  before  permitting  any  one  to  descend. 
Perhaps  the  readiest  method  of  exhausting  the  vitiated  air  in 
such  places  would  be  to  lower  heated  stones,  masses  of  hot  iron 
or  pails  of  hot  water,  to  near  the  bottom,  which  produce  a  rare- 
faction of  the  air  and  cause  it  to  ascend.  Its  place  will  then  be 
occupied  by  purer  air  from  without.  The  rarefaction  produced 
by  the  explosion  of  gun-powder  has  also  been  made  use  of  with 
success ;  but  this  has  some  objections,  because  the  combustion 
of  powder  itself  produces  gases  which  are  noxious  if  breathed 
in  large  quantity.  An  animal,  such  as  a  cat  or  dog,  should  be 
first  lowered  into  the  suspected  well  for  fifteen  or  twenty  min- 
utes, in  order  to  determine  whether  the  air  at  the  bottom  is 
capable  of  sustaining  life,  before  permitting  the  workmen  to 
descend.  Similar  precautions  should  be  used  in  old,  long- 
unused  mines  to  prevent  fatal  effects  from  the  so-called  "  choke- 
damp,"  which  is  largely  composed  of  carbon  dioxide. 

PRINCIPLES   OF   VENTILATION. 

During  ordinary  respiration  an  adult  human  being  adds 
900  grammes  =  455,500  cubic  centimetres  (14  cubic  feet)  of 
carbon  dioxide  to,  and  abstracts  744  grammes  =  516,500  cubic 
centimetres  (16  cubic  feet)  of  oxygen  from,  the  atmosphere  in 
twenty-four  hours.  Hence,  if  the  individual  were  confined  in 
an  apartment  where  the  inclosed  air  could  not  be  intermingled 
by  diffusion  with  the  atmosphere  without,  the  proportion  of 
carbon  dioxide  would  soon  become  so  great  that  the  processes 
of  life  could  not  be  sustained,  and  the  individual  would  die. 
This  result  would  be  reached  even  sooner  than  the  point  here 
mentioned,  for  the  organic  matter  exhaled  from  the  lungs  and 
the  surface  of  the  body  would  increase  the  poisonous  condition 
of  the  air  even  more  than  the  carbon  dioxide  given  off.  It  is 
easily  seen,  therefore,  how  important  the  study  of  the  principles 
and  practice  of  ventilation  becomes  in  hygiene.  In  this  chapter 
only  the  principles  underlying  this  subject  can  be  definitely 


PRINCIPLES    OF    VENTILATION.  39 

stated.  Practical  details  will  be  more  fully  given  in  the  chapters 
devoted  to  dwellings,  schools,  hospitals,  etc. 

It  is  generally  accepted  among  sanitarians  that  the  presence 
of  .07  per  cent.  (7  parts  in  10,000)  of  carbon  dioxide  in  the  air 
indicates  the  greatest  amount  of  organic  impurity  (from  respira- 
tion or  combustion)  consistent  with  the  preservation  of  health. 
As  each  individual  gives  off  from  his  lungs,  in  the  process  of 
respiration,  316  cubic  centimetres  of  carbon  dioxide  per  minute, 
the  diffusion  in  the  air  surrounding  him  must  be  sufficiently 
rapid  to  keep  the  air  to  be  breathed  at  the  standard  of  .07  per 
cent,  above  mentioned. 

Adopting  this  as  the  standard  of  maximum  impurity  allow- 
able, 90  cubic  metres  of  fresh  air  per  hour  will  be  needed  for 
each  individual  to  keep  him  supplied  with  pure  air.  This  is  for 
a  person  in  a  state  of  health ;  in  cases  of  disease  a  more  rapid 
change  of  air  will  be  necessary  to  keep  that  surrounding  the 
patient  in  a  state  of  purity. 

Ventilation  is  defined  by  Worcester  as  "  the  replacement 
of  noxious  or  impure  air  in  an  apartment,  mine,  or  inclosed 
space  by  pure,  fresh  air  from  without."  By  Dr.  Parkes  the 
term  is  restricted  to  "  the  removal  or  dilution,  by  a  supply  of 
pure  air,  of  the  pulmonary  and  cutaneous  exhalations  of  men 
and  the  products  of  combustion  of  lights  in  ordinary  dwellings, 
to  which  must  be  added,  in  hospitals,  the  additional  effluvia 
which  proceed  from  the  persons  and  discharges  of  the  sick.  All 
other  causes  of  impurity  of  air  ought  to  be  excluded  by  cleanli- 
ness, proper  removal  of  solid  and  liquid  excreta,  and  attention 
to  the  conditions  surrounding  dwellings."  1 

A  proper  system  of  ventilation  must  take  into  consideration 
the  cubic  space  of  the  apartment  or  building  to  be  ventilated, 
the  number  of  persons  ordinarily  inhabiting  this  space,  whether 
constantly  or  only  temporarily  occupied,  and  certain  other  col- 
lateral elements,  such  as  the  character  of  the  building  to  be 
ventilated,  its  exposure,  necessity  for  artificial  heating,  etc. 

1  Manual  of  Practical  Hygiene,  6th  ed.,  New  York,  vol.  i,  p.  157. 


40  TEXT-BOOK   OF   HYGIENE. 

The  amount  of  cubic  space  that  must  be  allowed  to  each 
individual  is  determined  by  the  rapidity  with  which  fresh  air 
must  be  supplied  in  order  to  keep  that  surrounding  the  indi- 
vidual at  the  standard  of  less  than  .07  per  cent,  of  carbon  dioxide. 
For  example,  in  a  space  of  3  cubic  metres,  the  air  must  be 
changed  thirty  times  in  an  hour,  in  order  to  prevent  the  carbon 
dioxide  exceeding  the  above  proportion;  that  is  to  say,  to  allow 
90  cubic  metres  of  air  to  pass  through  that  space  in  the  time 
mentioned.  This  would  create  an  uncomfortable,  if  not  injurious, 
draught.  If  the  space  contained  30  cubic  metres,  the  air  would 
need  renewal  only  three  times  an  hour. 

A  space  of  15  cubic  metres  could  be  kept  supplied  with 
pure  air  without  perceptible  movement  if  all  the  mechanical 
arrangements  for  changing  the  air  were  perfect ;  but  such  per- 
fection is  rarely  attainable,  and  hence  there  would  be  either 
draughts  or  insufficient  ventilation  in  such  a  small  "  initial  air- 
space," as  it  is  termed.  The  initial  air-space  should,  therefore, 
be  not  less  than  30,  or,  better,  40  cubic  metres.  The  air  of  this 
space  could  be  changed  sufficiently  often  to  keep  it  at  its  standard 
of  purity  without  creating  unnecessary  draught.  For  sick  per- 
sons this  should  be  doubled.  In  hospitals,  therefore,  the  cubic 
air-space  allowed  to  each  bed  should  not  be  less  than  60  to  80 
cubic  metres. 

As  stated,  the  purposes  for  which  the  building  or  apartment 
to  be  ventilated ,  is  employed  requires  differences  in  the  cubic 
space  and  in  the  volume  of  fresh  air  supplied.  Morin  gives  the 
following  table : — 


Table  III. 


Fresh  Air  Required 
per  Hour  per  Head. 


Hospital  wards  for  ordinary  cases,         .       60-70  cubic  metres. 
Hospital  wards  for  surgical  and  obstet- 
rical cases,       .         .         .         .         .100  "         " 
Hospital  wards  for  contagious  diseases,     150  "         " 
Prisons, .......      50  "         " 


PRINCIPLES   OF   VENTILATION.  41 


Workshops 

(ordinary  occupations, 
(unhealthy,        " 

60 
100 

cubic 

metres 

a 

Barracks, 

(during  the  day, 
X     "          "    night,  . 

.       30 
40-50 

a 
u 

a 
a 

Theatres, 

..... 

40-50 

u 

(( 

Assembly  rooms  for  long  receptions, 

GO 

(( 

a 

u 

"        "    brief        " 

.       30 

(( 

a 

Primary  schools,     .... 

.       12-15 

it 

u 

Higher 

u 

25-30 

u 

u 

180-200 

a 

u 

These  figures  are  not  excessive  from  a  sanitary  stand-pointy 
although  few  buildings  meet  the  requirements  here  set  down. 

The  source  of  the  air  supplied  must,  of  course,  be  capable 
of  yielding  pure  air.  It  should  not  be  drawn  from  damp  cellars 
or  basements,  or  from  the  immediate  vicinity  of  sewers  or  drains. 
Air  taken  from  such  places  is  little  better  for  respiration  than 
that  which  it  replaces  in  the  apartments  to  be  ventilated. 

Ventilation  may  be  accomplished  either  with  or  without 
artificial  aids.  In  buildings  or  rooms,  used  as  habitations, 
natural  ventilation  (with,  perhaps,  the  simplest  mechanical  aids) 
is  made  use  of  almost  entirely.  In  large  buildings,  such  as 
churches,  theatres,  schools,  or  in  ships  and  mines,  one  of  the 
artificial  systems  must  be  adopted  if  efficient  ventilation  is 
desired. 

Natural  ventilation  takes  place  by  diffusion,  by  perflation, 
and  in  consequence  of  inequality  of  atmospheric  pressure.  By 
diffusion  is  meant  the  slow  and  equable  entrance  of  air  from 
without  and  exit  from  within  a  room  through  the  walls  or  ill- 
made  joints  without  the  influence  of  wind-currents.  In  an 
occupied  room  this  is,  however,  insufficient  to  keep  the  air  pure, 
because  many  of  the  organic  impurities  of  respired  air  are  mole- 
cular, and,  therefore,  incapable  of  making  their  way  out  of  the 
rooms  through  the  walls. 

Perflation  means,  literally,  "  blowing  through,"  and,  if  the 
direction  and  force  of  air-currents  could  be  regulated,  this  would, 
with  simple  mechanical  arrangements,  be  an  efficient  means  of 


42  TEXT-BOOK    OF    HiGir,i\iS. 

ventilation.  However,  the  -uncertainty  of  the  force  and  direc- 
tion of  the  wind  makes  this  method  of  ventilation  untrustworthy, 
except  in  warm  weather. 

Unequal  pressure  between  the  air  in  a  room  and  that 
without  is,  within  certain  limits,  an  efficient  means  of  ventila- 
tion, and  is  usually  relied  upon  in  ordinary  apartments.  When 
the  air  in  a  room  is  heated  above  the  temperature  of  the  external 
aii%  either  by  a  fire,  lights,  or  by  the  presence  of  a  number  of 
persons  in  the  room,  it  expands,  and  part  of  it  finds  its  way  out 
through  numerous  crevices  and  bad  joints  found  in  all  buildings. 
The  air  which  remains,  being  less  dense  than  the  external  air, 
the  latter  enters  the  room  by  various  openings,  until  the  equality 
of  pressure  is  re-established.  But  as  the  heating  of  the  enclosed 
air  continues,  the  process  is  momentarily  repeated  and  becomes 
continuous. 

Although  the  impurities  of  respired  air  (carbon  dioxide, 
organic  matter)  are  heavier  than  the  air  itself  at  the  same 
temperature,  it  is  a  familiar  fact  that  the  most  impure  air  in  an 
occupied  room  is  always  found  near  the  ceiling,  the  impurities 
bein0,  carried  upward  with  the  heated  air,  and  that  the  pure  air 
from  without,  being  colder,  fills  the  lower  part  of  the  room. 

If  the  cold,  outside  air  were  to  be  admitted  at  the  bottom 
of  the  room,  and  means  allowed  for  the  escape  of  the  hot  air  at 
the  top,  the  conditions  of  the  old  health-maxim,  to  "  keep  the 
feet  warm  and  the  head  cool,"  would  be  reversed,  This  would 
be  no  less  uncomfortable  than  unwholesome.  In  all  plans  for 
natural  ventilation,  therefore,  provision  must  be  made  to  secure 
a  o-radual  diffusion  of  the  cold,  outside  air  from  above,  or  to 
have  it  warmed  before  it  enters  the  room.  With  a  large  chimney 
as  an  aspirating  shaft,1  with  flues  at  the  top  and  bottom  of  the 
room,  and  openings  in  the  walls  of  the  room  near  the  ceiling  to 
admit  fresh  air,  sufficient  ventilation  can  be  usually  secured  in 
cold  weather,  in  a  room  not  overcrowded. 

1  Of  course  there  is  really  no  s\ich  thing  as  a  real  aspiration,  or  "sucking  out"  of  the  air 
through  the  chimney  or  so-called  "aspirating  shaft."  The  upward  movement  of  the  air  in  the 
shaft  is  due  to  its  displacement  by  the  colder  or  denser  air  entering  the  room. 


PRINCIPLES   OF   VENTILATION.  43 

When  a  room  is  heated  by  a  furnace,  the  fresh  air  is  warmed 
before  it  is  introduced,  and  the  foul  air  escapes  either  through  a 
ventilating  shaft,  a  ventilator  in  the  window  or  wall,  or  through 
the  numerous  fissures  and  other  orifices  which  defective  car- 
pentering always  leaves  for  the  benefit  of  the  health  of  the 
occupants. 

The  following  rules  for  the  arrangement  of  a  system  of 
natural  ventilation  are  modified  and  condensed  from  Parkes1 : — 

The  apertures  of  entrance  and  of  exit  for  the  air  should  be 
placed  far  enough  apart  to  permit  thorough  diffusion  of  the 
fresh  air. 

When  the  air  is  brought  into  a  room  through  slits  or  tubes 
in  the  walls  near  the  ceiling,  the  current  should  always  be 
deflected  upward  by  an  inclined  plane,  in  order  to  prevent  a 
mass  of  cold  air  from  descending  over  the  shoulders  of  the 
occupants  and  chilling  them. 

The  air  must  be  taken  from  a  pure  source. 

The  inlet-tubes  should  be  short,  and  so  made  as  to  be  easily 
cleansed,  otherwise  dirt  lodges  and  the  air  becomes  impure. 

Inlets  should  be  numerous  and  small,  to  allow  a  proper 
distribution  of  the  entering  air. 

Externally,  the  inlets  should  be  partially  protected  from 
the  wind  to  prevent  strong  draughts ;  they  should  also  be  pro- 
Added  with  valves  to  regulate  the  supply  of  air. 

If  the  air  cannot  be  warmed,  the  inlets  must  be  near  the 
ceiling ;  if  it  can  be  heated,  it  may  enter  near  the  floor. 

The  air  may  be  warmed  by  passing  it  through  boxes  con- 
taining hot  water  or  steam  coils,  by  passing  it  through  chambers 
around  grates  or  stoves,  or  heating  it  in  a  furnace. 

In  towns  or  manufacturing  districts  the  air  should  be 
filtered  before  allowing  it  to  enter  the  room.  Thin  flannel  or 
muslin  spread  over  the  openings  answers  very  well  as  filtering 
material. 

Outlets  should  be  placed  at  the  highest  point  of  the  room 

1  Manual  of  Practical  Hygiene,  6th  ed.,  New  York,  vol.  i,  p.  177. 


44  TEXT-BOOK   OF   HYGIENE. 

and  should  be  protected  from  trie  weather.  An  opening  into  the 
chimney  near  the  ceiling  will  answer  well  in  many  cases. 

In  one-story  buildings,  ridge-ventilators  make  the  best  out- 
lets. The  entrance  of  snow  and  rain  must  be  prevented  by 
suitable  arrangements. 

A  small  space  or  slit  between  the  horizontal  bars  of  the 
upper  and  lower  window-sash  will  admit  sufficient  air  in  a  proper 
direction  in  small  rooms,  even  when  the  window  is  shut. 

In  all  rooms,  howsoever  ventilated,  doors  and  windows 
should  be  often  opened  to  permit  a  thorough  flushing  of  the 
interior  with  fresh  air. 

For  large  buildings,  hospitals,  schools,  theatres,  ships,  and 
mines  two  systems  of  artificial  ventilation  are  in  use.  One 
operates  by  extracting  the  foul  air  by  means  of  fans,  the  other 
by  forcing  in  fresh  air,  allowing  the  impure  air  to  find  its  way 
out  as  best  it  may. 

Further  details  upon  the  practical  application  of  these  prin- 
ciples will  be  given  in  succeeding  chapters  of  this  work. 

[In  addition  to  the  works  mentioned  in  the  text  the  follow- 
ing may  be  referred  to  as  more  fully  treating  of  the  subjects 
considered  in  this  chapter : — 

Flamniarion  :  The  Atmosphere. — The  Articles  on  Atmosphere  and 
Climate  in  the  Encyclopaedia  Britannica,  9th  edition. — Reports  of  the 
Chief  Signal  Officer  of  the  Army. — A  paper  on  Climate  and  Diseases,  by 
Dr.  Cleveland  Abbe,  in  Report  of  Nacional  Board  of  Health  for  1880. — 
Die  Canalgase,  by  Dr.  F.  Renk,  Munchen,  1884. — Morin  :  On  Warming 
and  Ventilating  Occupied  Buildings  ;  translated  in  Smithsonian  Report 
for  1873  and  1874. — T.  Pettenkofer  und  Ziemssen's  Handbuch  der  Hy- 
giene, I  Theil,  2  Abtheilung.  Die  Luft,  by  Dr.  F.  Renk.] 


CHAPTER  II. 

Water. 

Physiologists  teach  that  nearly  two-thirds  of  the  tissue  of 
the  animal  body  consists  of  water.  Inasmuch  as  this  water  is 
constantly  being  lost  by  evaporation  from  the  skin,  exhalation 
by  the  lungs,  and  excretion  through  various  organs,  it  is  evident 
that  the  loss  must  be  constantly  supplied  if  the  functions  of  life 
shall  be  properly  performed. 

It  appears  probable  that  certain  diseases  are  at  times  spread 
through  the  agency  of  insufficient  or  impure  drinking-water. 
It  is,  therefore,  a  matter  of  very  great  importance  to  have  a  defi- 
nite notion  of  what  constitutes  a  pure  and  sufficient  supply  of 
water,  and  how  best  to  secure  it,  to  be  able  to  detect  its  condi- 
tions of  purity  and  impurity,  and  to  know  how  to  maintain  the 
former  and  avoid  the  latter.  It  will  be  necessary  to  consider  in 
detail,  therefore,  the  quantity  of  water  required  by  each  indi- 
vidual for  the  maintenance  of  health,  the  sources  whence  water 
is  obtained,  how  it  should  be  collected  and  stored  to  the  best 
advantage,  the  impurities  likely  to  be  contained  in  it,  and  the 
methods  of  keeping  it  pure,  or  of  purifying  it  when  it  has 
become  polluted  or  vitiated  in  any  manner. 

THE    QUANTITY   OF   WATER    REQUIRED   BY   HUMAN   BEINGS. 

Dr.  Parkes,  after  a  number  of  experiments,  concluded  that 
a  man  of  the  English  middle  class,  "who  may  be  taken  as  a 
fair  type  of  a  cleanly  man  belonging  to  a  fairly  cleanly  house- 
hold," uses  about  twelve  gallons  of  water  per  day.  This  covers 
all  the  water  needed,  including  a  daily  sponge  bath.  Dr. 
DeChaumont  estimates1  that    16    gallons  should  be  the  daily 

1  Parkes'  Hygiene,  6th  ed,,  New  York,  voL  i,  p.  5. 

(45) 


46  TEXT-BOOK   OF   HYGIENE. 

allowance.  By  order  of  the  British  War  Department,  15  gal- 
lons of  water  are  allowed  to  each  soldier  daily.  In  very  many 
instances  this  quantity  cannot  be  furnished,  but  in  such  cases 
there  necessarily  results  some  deficiency  in  cleanliness.  It  is 
probable  that  among  the  poorer  classes,  especially  where  a  large 
supply  of  water  is  not  convenient,  the  quantity  used  is  not  over 
one-fourth  of  the  above  estimate. 

In  estimating  the  daily  supply  of  water  needed  in  a  com- 
munity, large  or  small,  other  circumstances  must  be  taken  into 
consideration  in  addition  to  the  demands  of  the  individual. 
For  example,  in  towns  or  cities  allowances  must  be  made  for 
animals,  manufacturing  purposes,  probable  waste,  fires,  sewerage, 
etc.  In  cities  an  allowance  of  50  gallons  daily  per  head  would 
not  be  excessive.  In  most  American  cities  the  supply  is  much 
greater.1  The  present  daily  supply  in  Baltimore,  which  is  de- 
rived from  an  excellent  source,  is  estimated  at  60  gallons  per 
head,  which  could  be  increased  to  three  times  that  quantity  if 
necessary. 

A  serious  problem,  affecting,  however,  the  engineer  rather 
than  the  sanitarian,  is  the  prevention  of  waste  of  water  in  places 
where  the  supply  is  limited.  It  is  estimated  that  in  Chicago 
one-half  of  the  water  pumped  is  wasted  through  negligence  and 
imperfections  in  the  supply  apparatus,  while  in  St.  Louis  the 
annual  cost  to  the  city  of  the  water  that  is  wasted  is  placed  at 
$400,000.  It  has  been  proposed  to  check  this  wanton  waste  by 
measuring  the  quantity  of  water  used  by  each  household  by 
means  of  a  meter,  as  the  supply  of  gas  is  now  measured,  and 
this  has  been  carried  into  effect  in  places.  There  are,  however, 
serious  objections  to  this  method.  One  of  the  objections  is  that 
the  very  class  of  persons  whom  it  is  desired  to  induce  to  use  a 
plentiful  supply  of  water  would,  from  motives  of  economy,  use 
less  than  is  necessary  for  cleanliness  and  health.  A  system  of 
vigilant  inspection  of  the  water  service  in  houses  would  probably 
serve  to  reduce  this  unnecessary  waste  to  a  considerable  extent. 

1  Buck's  Hygiene  and  Public  Health,  voL  i,  p.  214. 


SOURCES    OF    DRINKING-WATER.  47 

SOURCES   OF   DRINKING-WATER. 

All  water,  from  whatever  direct  source  obtained,  comes 
originally,  by  precipitation,  from  the  atmosphere.  In  many 
places  the  rain-  or  snow-  water  is  the  only  source  of  supply.  This 
is  usually  collected  as  it  falls  upon  the  roofs  of  buildings  and 
conveyed  by  gutters  and  pipes  to  cisterns,  where  it  is  stored  until 
needed. 

In  Venice,  the  rain  falling  upon  the  streets  and  court- 
yards is  also  collected  in  cisterns  after  filtering  through  sand. 
The  cisterns  used  for  the  storage  of  water  in  New  Orleans  and 
other  Southern  cities  in  the  United  States,  where  the  tempera- 
ture rarely  falls  below  the  freezing-point,  are  generally  con- 
structed of  wood  and  placed  above-ground.  Farther  north, 
where  it  is  necessary  to  protect  them  against  the  action  of  frost, 
they  are  placed  under-ground.  These  under-ground  cisterns  are 
usually  built  of  brick.  The  water  from  cisterns  above-ground 
becomes  very  much  heated  in  summer,  and  necessitates  the  use 
of  large  quantities  of  ice  to  make  it  palatable.  The  water  from 
the  under-ground  cisterns  is  pleasantly  cool  in  summer,  and  is 
also  guarded  against  freezing  in  winter,  There  are,  however, 
very  serious  objections  to  storing  drinking-water  in  under-ground 
cisterns.  These  reservoirs  are  usually  placed  within  a  few  feet 
of  privies  and  cess-pools,  and,  as  neither  the  retaining  walls  of 
the  cisterns  nor  those  of  the  privies  are  water-tight,  it  often 
happens  that  the  drinking-water  becomes  strongly  impregnated 
with  the  soluble  portions  of  the  excrement,  or  the  products  of 
its  decomposition,  which  have  drained  into  the  cistern.  Per- 
sonal observations  in  Memphis  in  1879,  as  well  as  the  careful 
chemical  analyses  made  afterward  by  Dr.  Chas.  Smart,  U.  S.  A.,1 
have  convinced  the  author  that  the  objections  to  all  under- 
ground cisterns  built  of  brick,  stone,  or  cement  are  insuperable 
from  a  sanitary  point  of  view.  Dr.  Smart  found  over  one-half 
of  the  under-ground  cisterns  examined  by  him  in  Memphis  and 

1  Report  National  Board  of  Health,  1880,  pp.  437-441. 


48  TEXT-BOOK   OF   HYGIENE. 

other  cities  and  towns  to  be  leaky  and  >  presenting  evidence  of 
organic  pollution.  The  water  from  31  out  of  80  cisterns  ana- 
lyzed showed  decided  contamination  by  sewage.  It  would  seem 
advisable  to  prohibit  all  under-ground  cisterns  for  the  storage  of 
drinking-water  unless  they  are  constructed  of  iron,  which  should 
be  protected  against  oxidation  by  a  thorough  coating  of  coal- 
tar.  Where  any  other  system  of  collection  and  storage  is  avail- 
able, however,  the  under-ground  cistern  should  be  unreservedly 
condemned. 

Rain-water  collected  in  the  country,  away  from  manufac- 
turing districts,  is  usually  quite  pure  and  wholesome.  Its  taste 
is,  however,  flat  and  insipid,  owing  to  absence  of  carbon  dioxide 
and  mineral  constituents.  In  cities  rain-water  frequently  con- 
tains such  a  large  amount  of  organic  matter  and  other  impurities, 
which  have  been  washed  out  of  the  air  by  the  rain,  that  it  may 
be  unfit  for  drinking.  On  account  of  its  softness,  rain-water  is 
very  desirable  for  washing  and  other  domestic  purposes.  If  the 
statement  made  in  the  last  chapter,  concerning  the  presence  of 
organisms  in  the  atmosphere,  is  remembered,  it  will  be  evident 
on  a  moment's  thought  that  such  organisms,  when  contained  in 
rain-water,  may  be  the  source  of  disease.  The  putrefaction 
which  so  readily  takes  place  in  rain-water  upon  standing  a  few 
days  is  caused  by  certain  of  the  organisms  carried  down  out  of 
the  lower  strata  of  the  air  by  the  descending  rain  or  snow. 

Precipitation  is  an  exceedingly  untrustworthy  source  of 
water,  and  should  never  be  depended  upon  when  other  sources 
of  supply  are  available.  Water  famines  are  frequent  wherever 
people  are  compelled  to  rely  upon  such  an  uncertain  source  of 
supply  as  rain  or  snow. 

Rivers  and  smaller  streams  probably  supply  the  larger 
number  of  cities  and  towns  in  this  country  with  drinking-water. 
When  care  is  taken  to  prevent  the  pollution  of  the  stream  above 
the  point  whence  the  water  is  taken,  this  is  usually  of  fair 
quality  for  domestic  purposes.  When  the  river  can  be  tapped 
near  its   source,  or  before  a  large  number  of  manufacturing' 


SOURCES   OF    DRINKING-WATER.  49 

establishments  can  empty  their  waste  products  into  its  current, 
or  before  it  receives  the  sewage  of  a  considerable  number  of 
inhabitants  living  on  its  banks,  the  water  can  generally  be  re- 
garded as  safe.  It  is  very  difficult,  however,  except  in  the  less 
settled  portions  of  the  country,  to  find  these  favorable  conditions 
present. 

Among  the  minor  objections  to  the  use  of  river-water  for 
domestic  purposes  are  the  liability  of  most  streams  to  become 
turbid  in  times  of  freshet,  and  the  discoloration  of  the  water 
from  dissolved  coloring-matters  if  the  stream  flows  through  a 
marshy  or  peaty  region.  These  objections  are,  however,  not 
serious,  as  filtration  will  readily  remove  the  suspended  matters. 
The  coloring-matter  is  probably  harmless.  The  organic  matter 
contained  in  the  water  of  some  streams,  even  when  pollution  by 
sewage  and  manufacturing  refuse  is  absolutely  excluded,  may, 
however,  be  the  cause  of  disease.  Dr.  Smart  has  shown1  that 
the  water  from  streams  in  Nebraska,  Wyoming,  and  Utah  con- 
tained organic  matter  varying  in  amount  from  .16  to  .28  parts 
per  million.2  He  thinks  the  so-called  "  mountain  fever  "  of  the 
Rocky  Mountain  region  is  a  malarial  fever  caused  by  the  large 
amount  of  organic  matter  in  the  drinking-water. 

Dr.  G.  M.  Kober,  U.  S.  A.,  states  that  he  has  frequently 
drunk  water  from  mountain  streams  which  had  a  perceptible 
taste  of  cattle-manure,  and  suggests  that  as  the  origin  of  the 
ammonia  found  by  Dr.  Smart  in  the  water  of  mountain  streams. 
Dr.  Kober  also  regards  the  "mountain  fever"  as  a  typhoid  fever 
with  malarial  complications.3 

The  most  serious  objection  to  the  use  of  river-water  for 
domestic  purposes  is  the  employment  of  streams  as  carriers  of 
refuse  from  manufacturing  establishments,  or  of  the  sewage  of 
cities  and  towns.  In  Great  Britain  and  some  parts  of  the  con- 
tinent of  Europe,  owing  to  the  density  of  population  and  the 

x  American  Journal  Med.  Sciences,  January,  1878,  p.  28  et  seq. 

2  The  source  of  this  organic  matter  seems  to  be  the  melted  snow  which  makes  up  a  large 
portion  of  the  streams. 

3  Report  of  California  State  Board  of  Health  for  1886,  pp.  48  and  177. 

4 


50  TEXT-BOOK   OF   HYGIENE. 

variety  and  extent  of  manufacturing  industries,  many  of  the 
streams  are  in  an  extremely  filthy  condition.  In  this  country, 
too,  especially  in  the  more  thickly  settled  manufacturing  districts 
of  New  England,  the  pollution  of  rivers  has  increased  to  a 
degree  to  seriously  jeopardize  the  health  of  the  people  who  are 
compelled  to  draw  their  water-supply  from  such  streams.  Several 
years  since  a  commission  was  appointed  by  the  State  Board  of 
Health  of  Massachusetts  to  inquire  into  the  extent  of  the  pollu- 
tion of  the  streams  in  that  State,  and  to  devise  means  for  pre- 
venting such  pollution.  The  commission  extended  its  inquiries 
and  observations  over  several  years,  reporting  the  result  to  the 
State  authorities  at  intervals.1  It  was  found  that  the  water  of  the 
Blackstone  River,  at  Blackstone,  where  it  crosses  the  State  line 
and  enters  Rhode  Island,  contained  over  10  per  cent,  of  sewage 
and  refuse  waters.2  Other  streams  in  Massachusetts  show 
similar  pollution.  That  the  presence  of  such  excessive  con- 
tamination renders  the  water  unsuitable  for  domestic  pur- 
poses must  appear  evident.  It  is  probable,  however,  that  the 
most  dangerous  of  the  polluting  matters  are  the  excreta  of 
human  beings,  especially  those  of  patients  suffering  from  certain 
specific  diseases,  such  as  typhoid  fever  or  cholera. 

Only  a  few  years  ago  it  was  a  generally-accepted  theory 
that  running-water,  though  polluted  by  sewage,  "purified  itself" 
after  flowing  a  distance  of  twelve  miles,  and  the  comforting  and 
reassuring  doctrine  is  still  held  by  many.  Recent  observations 
point  to  the  conclusion,  however,  that  the  self-purification  of 
rivers  is  not  entirely  to  be  relied  upon.  A  certain  proportion 
of  the  sewage,  it  is  true,  undergoes  oxidation  in  the  presence  of 
light  and  air  and  minute  organisms,3  and  so  becomes  changed 
into  other,  possibly  innocuous  compounds.  But  at  present  it  is 
not  known  what  proportion  or  what  kind  of  organic  matter 
does  undergo  this  change.  Another  portion  of  the  impurities 
is  deposited  upon  the  bottom  and  sides  of  the  stream,  having 

1  Reports  State  Board  of  Health  of  Massachusetts  for  1873,  1874,  1876, 1877,  1878,  1879, 1880. 

a  Report  State  Board  of  Health  of  Massachusetts,  1876,  p.  145. 

•Disinfection,  in  Eulenburg's  Realencyclopaidie  d.  ges.  Heilkunde.  vol.  iv.  p.  68. 


SOURCES   OF    DRINKING-WATER.  51 

been  only  held  in  suspension,  and  not  dissolved  in  the  water.  A 
portion  probably  forms  chemical  combinations  with  other  sus- 
pended or  dissolved  matters,  and  is  changed  into  compounds 
which  may  be  volatile  and  pass  off  into  the  air,  or  form  insoluble 
precipitates. 

The  remainder  is  rendered  less  perceptible  or  imperceptible 
to  chemical  means  by  dilution.  Every  stream  has  sources  of 
inflowing  water — feeders — which  increase  its  volume,  and  thus 
dilute  any  foreign  admixture. 

In  view  of  these  facts,  the  theory  of  the  self-purification 
of  streams,  as  formerly  held,  can  no  longer  be  regarded  as  true. 
But  it  is  unquestionably  true  that  running-water  does  regain  its 
purity  if  the  inflow  of  sewage  and  other  refuse  is  not  excessive. 
It  cannot  be  stated  with  confidence,  however,  when  a  stream, 
once  polluted,  becomes  fit  to  use  again.  Moreover,  as  it  is  not 
possible,  by  any  practicable  chemical  treatment  or  filtration  on 
a  large  scale,  to  make  a  polluted  water  absolutely  wholesome,  it 
is  safer  not  to  use  as  a  source  of  domestic  supply  a  stream  which 
is  known  to  have  been  seriously  contaminated  by  sewage  matters 
or  other  impurities. 

The  water  from  fresh-water  lakes  and  ponds  is  generally  to 
be  preferred  to  river-water  for  domestic  use.  It  is  less  liable  to 
become  turbid  from  time  to  time,  and,  except  in  the  case  of 
small  ponds,  inflow  of  sewage  is  not  likely  to  cause  fouling  of 
the  water  to  any  serious  extent.  When  the  supply  can  be 
drawn  from  large  lakes,  as  is  done  in  Chicago  and  other  cities 
on  the  great  lakes  of  the  United  States,  no  purer  or  better  source 
can  be  desired.  In  these  cases  the  point  whence  the  water  is 
taken  should  be  far  enough  from  shore  to  avoid  possibility  of 
sewage  contamination.  When  the  water-supply  is  taken  from 
small  ponds,  all  sewage  and  waste  products  from  houses  and 
factories  must  be  rigidly  excluded ;  otherwise,  diseases  attribu- 
table to  the  polluted  water  are  likely  to  arise  among  those  using 
the  same. 

The  water  in  small  lakes  and  storage  reservoirs  sometimes 


52  TEXT-BOOK   OF   HYGIENE. 

becomes  offensive  in  taste  and  odor.  The  water-supplies  of 
several  of  the  large  Eastern  cities  have  within  the  past  seven  or 
eight  years  at  times  had  a  peculiar  odor  and  taste  somewhat 
resembling  cucumbers.  After  considerable  study,  Prof.  Ira 
Remsen,  of  Baltimore,  found  the  cause  of  this  odor  and  taste 
in  a  minute  fresh- water  sponge,  the  Spongilla  fluviatilis.  A  still 
more  offensive  odor,  tersely  described  as  the  "  pig-pen  odor,"  is 
given  to  the  water  by  the  decay  of  certain  species  of  nostoc  and 
other  algae.  It  is  not  known  that  either  these  vegetable  or 
animal  organisms,  if  present,  render  the  water  prejudicial  to 
health. 

Ponds  are  often  used  as  sources  of  ice-supply.  It  was 
formerly  supposed  that  in  the  process  of  freezing,  solid  matters 
in  the  water  were  not  included  in  the  block  of  ice  when  con- 
gelation occurred.  Recent  observations  have  shown  the  falsity 
of  this  assumption.  In  1875,  an  outbreak  of  acute  intestinal 
disease  at  Rye  Beach,  New  Hampshire,  led  to  an  inquiry  by 
Dr.  A.  H.  Nichols,  which  disclosed  the  fact  that  the  ice  used 
contained  a  large  percentage  of  organic  matter.1  The  use  of 
ice  from  a  different  source  was  followed  by  an  almost  immediate 
disappearance  of  the  disease.  Upon  further  investigation  it 
was  discovered  that  the  impure  ice  had  been  gathered  from  a 
small,  stagnant  pond  into  which  a  small  brook  carried  large 
quantities  of  saw-dust  from  several  saw-mills.  The  water  of  the 
pond  was  loaded  with  organic  matter,  and  in  summer  the  gases 
of  decay  arising  from  it  were  very  offensive.  Chemical  exam- 
ination showed  that  the  ice  from  this  pond  contained  nearly  6 
parts  of  organic  matter  in  100,000,  while  in  pure  ice  the  organic 
matter  amounted  to  only  .3  part  in  100,000.  A  similar  inves- 
tigation into  the  character  of  the  ice  furnished  to  the  residents 
of  Newport,  R.  I.,  was  made  under  the  auspices  of  the  Sanitary 
Protection  Association  of  that  city.  The  ice,  which  was  cut 
from  ponds  in  the  immediate  neighborhood  of  the  city,  was 
found  to  contain  an  excessive  proportion  of  organic  matter. 

1  Report  Massachusetts  State  Board  of  Health,  1876,  p.  467. 


SOURCES    OF    DRINKING-WATER.  53 

Large  quantities  of  sewage  and  other  impurities  were  discharged 
into  these  ponds.1 

A  series  of  experiments  recently  made  by  Dr.  C.  P.  Pengra, 
of  Michigan,  shows2  that  the  purification  of  the  water  by  freezing 
is  in  no  sense  absolute.  In  experimenting  with  bacteria,  infusoria, 
and  other  organisms,  he  found  that  from  9  to  11  per  cent,  re- 
mained in  the  ice  and  retained  their  vitality,  so  that  when 
thawed  they  rapidly  multiplied,  and  there  was  no  apparent 
loss  of  numbers.  In  the  ordinary  process  of  freezing  the  upper 
portion  is  the  purest,  but  if  snow  or  rain  fall  upon  the  ice  and 
freeze  this  upper  layer  will  be  found  much  more  impure  than 
the  lower.  Rational  conclusions  from  these  experiments  are, 
that  ice  should  not  be  gathered  from  an  impure  source,  and  that 
an  early  harvest  of  the  ice  should  be  encouraged. 

In  a  very  recent  research,  Prudden  has  shown  that  typhoid 
bacilli  contained  in  water  are  not  entirely  destroyed  by  freezing, 
even  after  remaining  in  this  condition  for  103  days. 

Springs  and  wells  supply  the  water  for  most  persons  not 
aggregated  in  large  communities,  as  cities  and  towns.  Even  in 
the  latter  no  inconsiderable  quantity  of  the  water  used  for 
drinking  and  domestic  purposes  is  derived  from  wells.  Spring- 
water  usually  comes  from  a  source  at  a  considerable  depth  below 
the  surface;  that  is  to  say,  the  water  has  percolated  through 
thick  strata  of  soil  before  re-appearing  at  the  surface.  In  its 
passage  through  the  soil  it  has  lost  most  of  its  organic  matter, 
and  perhaps  taken  up  mineral  and  gaseous  constituents  in  larger 
quantities.  It  may  be  so  strongly  impregnated  with  the  latter 
as  to  vitiate  it  for  ordinary  use  and  to  render  it  valuable  as  a 
medicine.  Ordinarily,  however,  spring-water  is  clear,  cool,  and 
sparkling,  with  a  refreshing  taste  and  uniform  temperature,  and 
in  all  respects  an  agreeable  and  wholesome  beverage. 

The  character  of  well-water,  on  the  contrary,  is  often  justly 
open  to  grave  suspicion.     Being  derived  from  those  strata  of  the 

1  The  Dangers  of  Impure  Ice,  in  The  Sanitarian,  May,  1882. 

2  Private  communication  to  the  author.  The  memoir  of  Dr.  Pengra  has  been  published 
in  the  Report  of  the  Michigan  State  Board  of  Health  for  1884. 


54  TEXT-BOOK   OF   HYGIENE. 

soil  which  are  most  likely  to  be  contaminated  by  the  products 
of  animal  and  vegetable  decomposition,  the  wholesomeness  of 
the  water  is  inversely  proportional  to  the  degree  of  saturation  of 
the  soil  with  the  products  of  decay.  It  has  been  found  by 
experiment  that,  when  organic  matter  largely  diluted  with  water 
is  allowed  to  percolate  through  soil,  it  undergoes  a  gradual 
decomposition  in  the  presence  of  certain  minute  organisms, 
nitrates  and  nitrites  being  formed  at  the  expense  of  the  ammonia 
and  other  organic  combinations.  If,  however,  the  soil  is  saturated 
with  organic  matter  in  excess,  and  in  a  state  of  concentration, 
putrefaction  takes  place,  and  the  conversion  of  the  organic 
matter  into  nitrates  and  nitrites  is  retarded.  Hence,  the  drain- 
age of  diluted  sewage  through  a  stratum  of  porous  soil,  not 
already  saturated  with  putrefying  matters,  has  no  especially  bad 
significance,  even  if  the  liquid  should  reach  a  well  used  as  a 
source  of  drinking-water.  It  is  probable  that  by  the  time  the 
liquid  portion  of  the  sewage  reached  the  well  it  would  have 
arrived  at  that  point  when  it  could  truthfully  be  termed  pure 
water.  At  the  same  time  it  must  be  remembered  that  the  puri- 
fying power  of  the  soil  cannot  be  relied  upon  if  the  supply  of 
sewage  or  other  animal  or  vegetable  impurity  is  too  abundant. 

Distillation  is  sometimes  resorted  to  for  the  purpose  of  pro- 
curing drinking-water,  especially  at  sea.  Vessels  now  generally 
carry  a  still  for  this  purpose.  The  principal  objection  to  dis- 
tilled water  is  its  insipidity,  due  to  the  absence  of  carbon  dioxide 
and  mineral  constituents,  which  give  to  good  drinking-water  its 
savor.  Distilled  water  may  be  aerated  by  passing  it  in  fine 
streams  through  holes  in  the  bottom  of  a  cask,  elevated  so  as  to 
allow  the  water  to  pass  through  a  considerable  stratum  of  air. 
Lead  is  sometimes  taken  up  from  the  distilling  apparatus,  and 
may  cause  lead  poisoning  in  those  using  the  water. 

Drinking-water  is  sometimes  procured  by  melting  snow  or 
ice.  It  is  not  probable  that  water  derived  from  these  sources  is 
unwholesome,  although  there  is  strong  popular  prejudice  against 
it.      Ice  and  snow  may,  however,  contain  large  amounts  of 


SOURCES    OF    DRINKING-WATER.  55 

impurities,  as  already  referred  to,1  and  be  for  this  reason  unfit 
for  use. 

The  following  qualities  are  desirable  in  water  for  drinking 
and  domestic  purposes  : — 

1.  The  water  should  be  colorless,  transparent,  sufficiently 
aerated,  of  uniform  temperature  throughout  the  year,  and  with- 
out odor  or  decided  taste. 

2.  The  mineral  constituents  (magnesium  and  lime  salts) 
should  not  be  present  in  greater  proportion  than  4  or  6  parts 
per  100,000.  More  than  this  gives  to  water  that  quality  known 
as  "  hardness." 

3.  There  should  be  but  little  organic  matter  present,  and 
no  living  or  dead  animal  or  vegetable  organisms. 

4.  The  water  should  be  entirely  free  from  ammonia  and 
nitrous  acid,  and  should  contain  but  very  small  quantities  of 
nitrates,  chlorides,  and  sulphates. 

5.  It  should  contain  less  than  one  milligramme  of  lead  per 
litre.  A  larger  proportion  is  likely  to  be  followed  by  lead 
poisoning. 

IMPURITIES   IN   WATER. 

The  transparency  and  the  color  of  water  are  affected  by 
the  presence  of  suspended  or  dissolved  mineral  or  organic  mat- 
ters. If,  after  standing  for  a  time,  the  water  deposits  a  sedi- 
ment, this  is  dependent  upon  insoluble  matters.  If  the  sediment 
turns  black  when  heated  in  a  porcelain  capsule  over  an  alcohol 
or  gas  flame  it  contains  organic  matter.  If  the  sediment  or 
residue  effervesces  upon  the  addition  of  hydrochloric  acid  the 
presence  of  carbonates  is  indicated.  Water  may  be  colored  by 
metallic  salts  or  by  vegetable  matter.  It  may  also  contain  large 
quantities  of  mineral  or  organic  matter,  or  even  living  organ- 
isms, without  perceptibly  diminishing  its  transparency.  For 
example,  the  ova  of  tape-worms  may  exist  in  water  in  consider- 
able numbers,  and  yet  remain  perfectly  invisible  except  under 
the  microscope. 

1  See  pages  52  and  53. 


56  TEXT-BOOK    OF   HYGIENE. 

The  presence  of  sulphur  compounds,  or  of  various  vege- 
table and  animal  organisms  (sponges,  algse,  etc.1),  may  give  to 
water  an  unpleasant  odor  and  taste.  In  the  oil  regions  of  this 
country  most  of  the  drinking-water  is  contaminated  with  petro- 
leum, which  is  very  disagreeable  to  one  unaccustomed  to  it.  It 
is  not  probable  that  the  small  quantities  of  the  oil  imbibed  with 
the  water  have  any  deleterious  influence  upon  the  organism. 

Many  works  on  hygiene  fix  a  limit  to  the  amount  of  solid 
matter  allowable  in  drinking-water.  The  International  Con- 
gress of  Hygiene,  at  Brussels,  fixed  the  limit  at  50  parts  in 
100,000.  It  is  impossible,  however,  to  say  of  any  particular 
specimen  of  water  that  its  content  of  solid  matter,  whether  or- 
ganic or  mineral,  will  be  prejudicial  to  health  without  trial.  At 
the  same  time  it  is  prudent  to  reject  all  waters  containing  a  con- 
siderable proportion  of  solid  organic  matter,  as  determined  by 
the  degree  of  blackening  on  heating  the  sediment  or  residue 
after  evaporation. 

The  hardness  of  water  is  due  to  the  presence  of  earthy  car- 
bonates, or  sulphates,  or  both.  If  the  hardness  is  due  to  car- 
bonates it  is  dissipated  by  heat,  as  in  boiling  the  water ;  the 
carbon  dioxide  is  driven  off,  and  the  base  (calcium  or  magnesium 
oxide)  is  precipitated  upon  the  bottom  and  sides  of  the  vessel. 
This  is  termed  the  "removable  hardness."  The  hardness  due 
to  the  presence  of  earthy  sulphates  is  not  removed  upon  heating 
the  water,  and  is  termed  the  "permanent  hardness."  The  hard- 
ness depending  upon  both  the  carbonates  and  sulphates  is  called 
the  "total  hardness." 

The  proportion  of  the  above-mentioned  earthy  salts  present 
in  a  given  specimen  of  water  is  determined  by  what  is  called  the 
soap  test.  This  test  depends  upon  the  property  which  lime  and 
magnesia  salts  possess  of  decomposing  soap  (oleate  and  stearate 
of  soda).  The  quantity  of  a  solution  of  soap  of  a  definite  com- 
position decomposed  by  a  quantity  of  hard  water  indicates  the 
amount  of  the  salts  present.     In  this  country  and  England  this 

1  See  page  52. 


IMPURITIES   IN    WATER.  57 

is  generally  expressed  in  degrees  of  Clark's  scale,  which  are 
equivalent  to  grains  of  carbonate  of  lime  per  imperial  gallon. 
Thus,  if  the  chemist  says  that  a  certain  sample  of  water  has  a 
total  hardness  of  16  degrees  he  means  that  the  earthy  salts  in  the 
sample  decompose  the  same  quantity  of  soap  that  would  be  de- 
composed by  16  grains  of  carbonate  of  lime  per  imperial  gallon. 
In  Germany  each  degree  of  the  scale  used  expresses  the  soap 
decomposed  by  1  part  of  calcium  oxide  per  100,000.  In  the 
scale  used  in  France  each  degree  corresponds  to  1  part  of  car- 
bonate of  lime  in  100,000.  So  much  of  the  hardness  of  water 
as  is  due  to  carbonates  can  be  dissipated  by  boiling,  which  drives 
off  the  free  carbon  dioxide  and  allows  the  insoluble  oxides  to 
be  deposited  as  an  incrustation  upon  the  bottom  and  sides  of 
the  vessel. 

The  standard  soap  solution  for  testing  the  hardness  of 
water  is  made  as  follows :  Dissolve  10  grammes  of  Castile  soap 
in  a  litre  of  weak  (35  per  cent.)  alcohol.  One  cubic  centimetre 
of  this  solution  precipitates  1  milligramme  of  carbonate  of  lime. 
The  test  is  made  as  follows :  To  a  definitely-measured  quantity 
of  water  (say  100  cubic  centimetres)  in  a  graduated  burette  a 
quantity  of  the  soap  solution  is  added  and  the  mixture  shaken 
up;  so  long  as  there  are  dissolved  lime  or  magnesium  salts  in 
the  water  the  soap  is  decomposed  and  no  lather  is  formed.  Soap 
solution  is  now  added  gradually  and  the  shaking  repeated  until 
there  is  evidence  of  saponification  by  the  formation  of  a  more  or 
less  permanent  lather  or  froth.  The  quantity  of  soap  solution 
used  is  noted,  and  the  test  is  repeated.  The  mean  of  the  quan- 
tity of  soap  solution  in  cubic  centimetres  used  in  the  two  ex- 
periments will  represent  approximately  the  proportion  of  salts  in 
grains  of  carbonate  of  lime  per  gallon  present,  or,  as  it  is  gen- 
erally expressed,  in  "degrees  of  hardness." 

The  scale  on  the  following  page  shows  the  quantity  of 
soap  solution  required  to  decompose  the  proportion  of  calcium 
oxide  per  100,000/ 

1  Uffelniann,  Handbuch  der  Hygiene,  p.  94. 


58  TEXT-BOOK    OF   HYGIENE. 

Table  IT. 
1     part  CaO  per  100,000  water  requires  5.4  c.cm.  standard  soap  solution. 


2     parts 

3 

u 

4 

a 

5 

n    ' 

6 

u 

6.5 

u 

7.0 

a 

7.5 

a 

8.0 

a 

8.5 

u 

9.0 

u 

9.5 

u 

10.0 

a 

10.5 

a 

11.0 

it 

11.5 

a 

12.0 

a 

9.4 

u 

u 

a 

13.2 

u 

a 

a 

17.0 

u 

a 

u 

20.8 

a 

a 

u 

24.4 

a 

a 

a 

26.2 

u 

a 

a 

28.0 

u 

a 

u 

29.8 

u 

u 

a 

31.6 

a 

a 

a 

33.3 

u 

u 

a 

35.0 

a 

a 

u 

36.7 

u 

a 

u 

38.4 

u 

a 

a 

40.1 

a 

a 

a 

41.8 

a 

u 

a 

43.4 

u 

a 

a 

45.0 

u 

a 

a 

If  there  are  more  than  12  parts  of  lime  in  100,000  the 
water  is  diluted  with  an  equal  proportion  of  distilled  water  and 
the  resultant  multiplied  by  two. 

Mr.  Wynter  Blyth  has  proposed  to  take  the  total  residue 
as  representing  approximately  the  total  hardness  of  the  water, 
but  Dr.  Fox  points  out  that  there  may  be  a  large  excess  of  in- 
organic solids  present  in  water  that  is  quite  soft  and  originally 
pure. 

Hard  water  is  objectionable  for  domestic  use,  as  it  is  waste- 
ful of  soap.  In  cooking  certain  vegetables,  such  as  peas  and 
beans,  the  hulls  are  not  thoroughly  softened.  In  making  infu- 
sions of  tea  and  coffee,  larger  quantities  of  these  materials  are 
needed  than  where  soft  water  is  used. 

DISEASES   DUE    TO   IMPURE    DRINKING-WATER. 

Hard  water  is  popularly  believed  to  be  the  cause  of  calcu- 
lous diseases,  and  of  goitre  and  cretinism,  but  no  reliable  obser- 
vations are  on  record  showing  that  the  belief  is  founded  upon 


DISEASES    DUE   TO   IMPURE   DRINKING-WATER.  59 

fact.  At  the  same  time  it  is  undoubtedly  true  that  calcareous 
waters  produce  gastric  and  intestinal  derangements  in  those 
unaccustomed  to  their  use.  •  • 

Large  amounts  of  suspended  mineral  matter  are  frequently 
present  in  river-water,  and  may  give  rise  to  derangements  of  the 
digestive  organs.  If  there  is  carbonate  of  lime  present,  the 
water  can  be  easily  clarified  by  the  addition  of  a  small  quantity 
of  alum.  Sulphate  of  lime  and  a  bulky  precipitate  of  hydrate 
of  alumina  are  formed,  which  carry  the  suspended  matters  to 
the  bottom.  About  10  centigrammes  of  crystallized  alum  are 
sufficient  to  clarify  a  litre  of  water.  This  amount  of  alum  is 
too  small  to  affect  the  taste  of  the  water  perceptibly.  This 
method  is  frequently  used  to  clarify  and  render  fit  for  use  the 
water  of  the  Mississippi  River,  which  is  usually  very  muddy. 
Dr.  Parkes  quotes  the  following  striking  instance  of  the  prac- 
tical value  of  clarifying  muddy  water  by  means  of  alum.1  In 
1868  the  right  wing  of  the  Ninety-second  Regiment  of  High- 
landers, going  up  the  river  Indus,  suffered  from  diarrhoea  from 
the  use  of  the  water,  which  was  very  muddy.  The  left  wing 
of  the  same  regiment  used  water  from  the  same  source,  but  pre- 
cipitated the  suspended  matters  with  alum  and  had  no  diarrhoea. 
The  right  wing  then  adopted  the  same  plan  with  like  success. 
Although  the  opinion  is  widespread  that  water  containing  much 
mineral  matter,  either  in  solution  or  in  suspension,  is  deleterious 
to  health,  there  is  very  little  evidence  absolutely  trustworthy 
upon  this  point. 

The  presence  of  large  quantities  of  organic  matter  in  water, 
whether  these  matters  be  of  animal  or  vegetable  origin,  must 
always  be  looked  upon  with  suspicion.  The  observation  was 
made  by  Hippocrates  twenty-three  centuries  ago,  that  persons 
using  the  water  from  marshes,  i.e.,  water  containing  vegetable 
matter,  suffer  from  enlarged  spleens.  Many  physicians,  both  of 
ancient  and  modern  times,  seem  to  have  held  this  opinion,  but 
the  first  positive  observation  in  medical  literature  is  the  now 

1  Manual  of  Practical  Hygiene,  6th  ed.,  New  York,  vol  i,  p.  341. 


60  TEXT-BOOK   OF   HYGIENE. 

classical  one  of  the  ship  Argo,  reported  by  Boudin.1  In  1834 
the  transport  Argo,  in  company  with  two  other  vessels,  carried 
800  soldiers  from  Bona,  in  Algiers,  to  Marseilles.  The  troops 
were  all  in  good  health  when  they  left  Algiers.  All  three  of 
the  vessels  arrived  in  Marseilles  on  the  same  day.  In  two  of  them 
there  were  680  men,  not  one  of  whom  was  sick.  Out  of  the 
remaining  120  men  who  were  on  the  third  vessel,  the  Argo,  13 
died  during  the  passage,  and  98  of  the  107  survivors  suffered 
from  paludal  fevers  of  all  forms.  None  of  the  crew  of  the 
Argo  were  sick,  however.  The  two  vessels  exempt  from  sick- 
ness, and  the  crew  of  the  Argo,  had  been  supplied  with  pure 
water,  while  the  soldiers  on  the  latter  vessel  had  been  furnished 
with  water  from  a  marsh.  This  water  was  said  to  have  a  dis- 
agreeable odor  and  taste.  The  testimony  of  a  large  number  of 
East  India  physicians  is  also  quoted  by  Parkes  in  support  of 
the  view  that  malarial  fevers  are  often  caused  by  impure  drink- 
ing-water. The  observations  of  Dr.  Charles  Smart,  upon  the 
production  of  "mountain  fever"  of  the  Western  territories, 
have  already  been  referred  to.  The  author  ventures  to  state  it 
as  his  opinion,  however,  that  the  instances  in  which  malarial 
fevers  are  due  to  impure  drinking-water  are  very  rare. 

The  causation  of  typhoid  fever  and  cholera  by  impure 
drinking-water  will  be  presently  referred  to.  Recently  the 
opinion  has  been  expressed  by  some  that  yellow  fever  and  diph- 
theria are  also  spread  by  polluted  drinking-water,  but  no  strong 
evidence  has  yet  been  adduced  in  its  support. 

There  can  be  very  little  doubt  that  diarrhoea  and  dysentery 
are  frequently  caused  by  water  which  has  been  contaminated 
with  decaying  organic  matter.  The  evidence  in  favor  of  this 
amounts  practically  to  demonstration. 

It  must  not  be  forgotten  that  the  ova  of  certain  animal 
parasites,  such  as  distoma  hematobium,  filaria  sanguinis  hominis, 
and  medinensis,  anchylostoma  duodenale,  and  possibly  of  round- 

1  Quoted  in  Parkes,  op.  cit,  p.  48 ;  Nowak,  Lelirbuch  der  Hygiene,  p.  51 ;  and  in 
numerous  other  publications  on  Hygiene. 


DISEASES   DUE   TO   IMPURE    DRINKING-WATER.  61 

and  tape-  worms,  for  example,  are  taken  into  the  system  along 
with  the  drinking-water. 

Organic  detritus  of  various  kinds,  sewage,  decomposing 
animal  and  vegetable  matter,  refuse  from  manufacturing  estab- 
lishments, may  be  a  source  of  pollution  of  water  and  render  it 
unfit  for  drinking  or  other  domestic  purposes.  It  is,  however, 
not  certain  that  water  thus  rendered  unclean  is  prejudicial  to 
health;  in  fact,  Dr.  Emmerich,  of  Munich,  has  recently, put  his 
skepticism  on  this  point  to  a  practical  test.  For  two  weeks  he 
drank  daily  from  half  a  litre  to  a  litre  of  very  filthy  water;  in 
fact,  nothing  less  than  sewage.  The  water  was  both  chemically 
and  physically  exceedingly  impure.  Several  of  the  experi- 
menter's patients  partook  of  the  same  water  without  any  ill 
effect.  He  even  claims  that  a  gastric  catarrh,  from  which  he 
was  suffering  when  the  experiment  was  begun,  was  improved 
during  its  course.1 

The  results  of  Emmerich's  experiments,  and  of  other  well- 
known  observations,  seem  almost  conclusive  that  the  products  of 
animal  and  vegetable  decomposition,  taken  into  the  body  with 
the  drinking-water,  cannot  be  looked  upon  as  certainly  harmful. 
Should,  however,  water  containing  such  impurities,  or  even 
water  apparently  pure,  contain  the  germs  of  one  of  the  specific 
diseases, — cholera,  typhoid  fever,  or,  perhaps,  yellow,  malarial, 
or  scarlet  fevers,  or  diphtheria, — it  is  probable  that  such  diseases 
would  be  communicated  to  the  consumer  of  the  water. 

Many  instances  are  on  record  where  outbreaks  of  typhoid 
fever  have  been  clearly  attributable  to  pollution  of  the  drinking- 
water  by  the  germ  of  the  disease  from  a  previous  case. 

One  of  the  most  remarkable  of  these  outbreaks  is  that  re- 
corded by  Dr.  Thorne.2  About  the  end  of  January,  1879, 
typhoid  fever  began  suddenly  in  the  adjoining  towns  of  Cater- 
ham  and  Red  Hill.     Within  six  weeks  352  cases  occurred.     All 

1  Wolffhuegel :  Wasserversorgung,  in  Pettenkofer  u.  Ziemssen's  Handbuch  der  Hygiene, 
I  Abth.,  II  Hlfte,  p.  97. 

3  Report  of  the  medical  officer  to  the  Local  Government  Board  for  1879.  Quoted  in  Fo- 
dor :  Hygienische  Untersuchungen,  etc.,  II  Abth.,  p.  261. 


62  TEXT-BOOK   OF  HYGIENE. 

other  sources  of  the  disease  were  excluded  except  the  drinking- 
water,  to  pollution  of  which  it  was  traced  with  almost  absolute 
certainty.  Caterham  contained  558  houses  and  Red  Hill  1700. 
Of  the  former  419  and  of  the  latter  924  drew  their  drinking- 
water  from  a  common  supply,  having  its  source  in  a  well  several 
hundred  feet  deep.  The  insane  asylum,  with  2000  inmates,  and 
the  military  barracks  in  Caterham  used  water  from  a  private 
well.  There  was  no  typhoid  fever  among  the  last  two  commu- 
nities. During  January  one  of  the  workmen  engaged  in  some 
excavation  near  the  public  well  was  taken  ill  with  diarrhoea  and 
fever, — probably  typhoid, — but  was  still  able  to  continue  his 
work.  His  dejections  were  often  voided  where  they  were  cer- 
tain to  become  mingled  with  the  water  of  the  common  supply. 
This  man's  diarrhoea  began  on  January  5th  and  continued  until 
the  20th  of  the  month,  during  which  time  he  remained  at  work. 
On  the  latter  date  he  was  compelled  to  quit  work  and  take  to 
his  bed.  Exactly  two  weeks  from  the  beginning  of  the  man's 
sickness,  on  January  19th,  the  first  case  of  typhoid  occurred  in 
Caterham,  and  then  rapidly  increased.  The  first  case  occurred, 
therefore,  just  fourteen  days — the  incubative  period  of  typhoid 
— after  the  presumed  infection  of  the  drinking-water  by  the  de- 
jections of  the  sick  laborer,  who  had  come  from  Croydon,  where 
typhoid  fever  was  at  the  time  prevalent.  Within  two  weeks 
from  the  appearance  of  the  first  case  the  epidemic  had  reached  its 
height,  and  then  rapidly  declined,  disappearing  almost  entirely  in 
a  month  after  the  outbreak.  It  was  shown  by  Dr.  Thorne  that 
nearly  all  the  houses  in  which  the  disease  appeared  were  sup- 
plied with  water  from  the  source  above  mentioned,  while  other 
houses  in  the  immediate  vicinity  of  the  infected  ones  remained 
free  from  the  disease. 

In  1874  there  was  an  outbreak  of  typhoid  fever  in  the 
town  of  Over  Darwen,  in  which  nearly  10  per  cent,  of  the  in- 
habitants were  attacked.  Here  the  source  of  the  disease  was 
also  traced  to  an  infected  water-supply. 

Dr.  Buchanan  has  shown  that  an  outbreak  among  the  stu- 


DISEASES   DUE   TO   IMPURE   DRINKING-WATER.  63 

dents  of  the  University  of  Cambridge  was  likewise  attributable 
to  an  infected  water-supply. 

In  this  country  the  reports  of  the  Boards  of  Health  of  the 
various  States  teem  with  accounts  of  localized  outbreaks  of 
typhoid  fever,  referred  to  infected  or  polluted  drinking-water. 
In  most  instances  the  evidence  furnished  by  the  observers  is  not 
conclusive.  In  many,  however,  especially  of  those  found  in  the 
Massachusetts  and  Michigan  reports,  the  fact  of  the  communi- 
cation of  the  disease  in  this  manner  seems  unquestionable.  One 
of  these  is  as  follows :  Out  of  40  families,  all  using  water 
from  a  certain  well,  there  occurred  23  cases  of  typhoid  fever. 
Out  of  47  families,  living  in  the  same  neighborhood,  but  using 
water  from  different  sources,  only  2  had  typhoid  fever.1  Dr.  C. 
F.  Folsom  has  published  a  very  suggestive  account  of  a  house 
epidemic,2  where  9  persons  in  a  single  house,  who  all  drank  water 
from  a  well  which  was  proven  to  be  infected  from  a  privy,  were 
attacked  by  this  disease. 

In  1885  an  epidemic  of  typhoid  fever  began  in  Plymouth, 
a  mining  town  of  8000  or  9000  inhabitants,  situated  in  the 
Wyoming  coal  region  of  Pennsylvania,  and  on  the  right  bank 
of  the  Susquehanna  River.  The  epidemic  began  in  April,  and 
lasted  until  the  ensuing  September.  There  were  1104  persons 
attacked  by  the  disease,  of  which  number  114,  or  10.3  per  cent., 
died.  The  careful  inspection  made  into  the  history  of  this 
epidemic  revealed  the  fact  that  the  public  water-supply  had 
unquestionably  become  polluted  by  the  faecal  discharges  of 
typhoid-fever  patients,  and  the  entire  course  of  the  disease,  in 
this  instance,  is  in  complete  accord  with  the  view  that  the  origin 
and  spread  of  the  epidemic  were  due  to  the  pollution  of  the 
drinking-water  with  the  typhoid-fever  poison. 

In  addition,  Chantemesse  and  Vidal  have  demonstrated  the 
presence  of  the  bacillus  of  Eberth,  which  is  now  generally  rec- 
ognized as  the  cause  of  typhoid  fever,  in  drinking-water  from 

1  Transactions  Mich.  Med.  Society,  p.  401,  1883. 

8  Boston  Med.  and  Surg.  Journal,  vol.  cii,  pp.  227,  261. 


64  TEXT-BOOK   OF   HYGIENE. 

a  well  near  Paris,  to  which  a  small  outbreak  of  typhoid  had 
been  traced.  This  demonstration  has  also  been  furnished  bv 
Prof.  V.  C.  Vaughan,  in  connection  with  an  outbreak  of  the 
same  disease  in  the  State  of  Michigan. 

The  numerous  cases  of  typhoid  fever  which  have  been 
attributed  to  the  use  of  infected  milk  may  be  included  in  this 
category.  It  is  probable  that  the  milk  became  infected  either 
through  polluted  water  used  for  the  purpose  of  cleansing  the 
milk-vessels  or  in  diluting  the  milk.  Mr.  Ernest  Hart  has  re- 
corded1 50  epidemics  of  typhoid  fever,  15  of  scarlet  fever,  and 
7  of  diphtheria,  the  cause  of  which  he  has  attributed  to  infected 
milk. 

It  is  probable  that  typhoid  fever  is,  in  the  majority  of  cases, 
spread  through  the  medium  of  polluted  drinking-water,  and,  in 
many  of  the  instances  on  record,  the  relations  between  cause 
and  effect — impure  water  and  typhoid  fever — have  been  so  clearly 
made  out  as  to  no  longer  permit  any  doubt  upon  the  question. 

As  it  is  with  typhoid  fever,  so  also  with  cholera.  In  a  later 
chapter  the  origin  and  propagation  of  typhoid  fever  and  cholera 
will  be  discussed  more  fully.  At  the  present  time  only  the  rela- 
tions of  the  drinking-water  to  the  spread  of  these  diseases  can 
be  considered.  In  the  instance  to  be  presently  noted  the  con- 
nection between  the  infected  water,  on  one  hand,  and  the  out- 
break of  cholera,  on  the  other,  is  so  clearly  shown  as  to  be 
almost  equivalent  to  a  mathematical  demonstration.  The  facts 
in  the  case  were  brought  to  light  after  a  patient  inquiry  by  a 
commission,  whose  report  drawn  up  by  Mr.  John  Marshall  has 
made  the  occurrence  classical.  In  1854  the  people  of  a  well-to- 
do  and  otherwise  healthy  district  in  the  eastern  part  of  London 
suffered  severely  from  cholera.  Upon  inquiry  the  fact  was 
elicited  that  a  child  had  died  of  cholera  at  No.  40  Broad  Street, 
and  that  its  excreta  had  been  emptied  into  a  cess-pool  situated 
only  three  feet  from  the  well  of  a  public  pump  in  that  street, 
from  which  most  of  the  neighboring  people  took  their  drinking- 

1  Transactions  Seventh  Int.  Med.  Congress,  vol.  iv,  p.  391, 1881. 


DISEASES   DUE    TO   IMPURE   DRINKING-WATER.  65 

water.  It  was  further  discovered  that  the  bricks  of  the  cess- 
pool wall  were  loose  and  permitted  its  contents  to  drain  into 
the  pump-well.  (It  should  be  noted  that  the  communication 
between  the  cess-pool  and  well  was  direct ;  that  there  was  im- 
mediate drainage,  not  percolation  through  the  soil.)  In  one 
day  140  to  150  people  were  attacked,  and  it  was  found  that 
nearly  all  the  persons  who  had  the  malady  during  the  first  few 
days  of  the  outbreak  drank  the  water  from  the  pump.  When 
the  pump  was  closed  to  public  use  by  the  authorities  the  epi- 
demic subsided.  The  most  singular  case  connected  with  this 
outbreak  was  the  following :  In  West  End,  Hampstead,  several 
miles  away  from  Broad  Street,  there  occurred  a  fatal  case  of 
cholera  in  a  woman  59  years  old.  This  woman  formerly  lived 
in  Broad  Street,  but  had  not  been  there  for  many  months.  A 
cart,  however,  went  daily  from  Broad  Street  to  West  End, 
carrying,  among  other  things,  a  large  bottle  of  water  from  the 
pump  referred  to.  The  old  lady  preferred  this  water  to  all 
others,  and  secured  a  daily  supply  in  the  manner  stated.  A 
niece,  who  was  on  a  visit  to  the  old  lady,  drank  of  the  same 
water.  She  returned  to  her  home,  in  a  high  and  healthy  part 
of  Islington,  was  likewise  attacked  by  cholera  and  died.  There 
were,  at  this  time,  no  other  cases  of  cholera  at  West  End,  nor  in 
the  neighborhood  of  these  last  two  persons  attacked. 

Most  of  the  English  medical  officers  in  India  hold  strongly 
to  the  view  that  cholera  is  spread  by  polluted  drinking-water, 
and  the  evidence  in  its  favor  is  very  strong. 

Quite  recently  (in  1885)  Dr.  Robert  Koch  discovered  the 
cholera  spirillum  in  a  water-tank  in  Calcutta,  used  as  a  source 
of  domestic  supply,  and  in  this  way  furnished  another  link  in 
the  chain  of  evidence  connecting  the  spirillum,  the  drinking- 
water,  and  the  outbreak  of  the  disease. 

The  evidence  in  favor  of  the  influence  of  impure  drinking- 
water  on  the  causation  of  other  diseases  than  those  mentioned 
is  not  sufficient  to  justify  any  conclusions  at  present. 

The  source  of  a  water-supply  may  be  pure,  yet  pollution 


66  TEXT-BOOK   OF   HYGIENE. 

may  occur  before  the  water  is  used  by  the  persons  to  whom 
it  is  distributed.  Supply-pipes  may  become  defective,  and  the 
water  become  contaminated  with  sewage  or  other  deleterious 
substances.  It  is  a  current  belief  that  no  impurity  can  gain 
access  to  hydrant-pipes  between  the  reservoir,  or  source  of 
supply,  and  the  point  of  discharge  of  the  water.  Nevertheless, 
such  contamination  may  occur  very  readily.  The  author  and 
his  colleague,  Dr.  J.  W.  Chambers,  of  Baltimore,  proved  this 
conclusively  a  few  years  ago  by  establishing  an  undoubted  con- 
nection between  a  house-epidemic  of  typhoid  fever  and  a  defect 
in  the  hydrant  supplying  the  family  with  water.1  The  hydrant 
was  one  of  the  class  known  as  Clark's  patent  non-freezing 
hydrant.  The  mechanism  of  these  hydrants  is  as  follows :  At 
the  lower  end  of  the  vertical  discharge-pipe  is  a  glazed  earthen- 
ware plunger,  which  works  through  a  ring  of  rubber  packing 
into  a  vacuum  chamber.  At  the  bottom  of  the  vacuum  chamber 
is  a  valve  regulating  the  entrance  of  the  water  from  the  con- 
ducting-pipe.  When  the  water  is  shut  off  this  valve  is  kept 
closed  by  a  spiral  spring.  When  the  crank  of  the  hydrant  is 
turned  forward — that  is,  when  the  water  is  "  turned  on " — the 
plunger  is  forced  to  the  bottom  of  the  vacuum  chamber,  presses 
on  the  spring,  opens  the  valve,  and  allows  the  water  to  dis- 
charge. When  the  crank  is  turned  back  the  plunger  is  raised, 
releases  the  spiral  spring,  which  forces  the  valve  into  its  bed,  and 
shuts  off  the  water.  The  partial  vacuum  produced  by  the 
raising  of  the  plunger  draws  the  water,  which  is  in  the  vertical 
discharge-pipe,  into  the  vacuum  chamber,  which  is  so  far  below 
the  surface  as  to  be  unaffected  by  frost.  In  course  of  time, 
and  with  use,  the  rubber  packing  gets  worn  and  permits  gradual 
leakage  into  the  vacuum  chamber  of  the  dirty  stagnant  water 
by  which  this  part  of  the  hydrant  is  always  surrounded.  Out- 
breaks of  typhoid  fever  having  a  similar  origin,2  in  which  the 

1  On  Preventable  Pollution  of  Hydrant-Water  and  its  Relation  to  the  Spread  of  Ty. 
phoid  Fever.    Maryland  Med.  Journal,  vol.  vii,  p.  271. 

2  Local  Causes  of  Insanitation  in  Baltimore,  by  John  Morris,  M.D.    Report  Md.  State 
Board  of  Health,  1878. 


DISEASES   DUE    TO   IMPURE   DRINKING-WATER.  67 

connection  between  cause  and  effect  was  clearly  shown,  have 
been  reported  by  other  physicians  of  the  same  city. 

Aside  from  the  practical  question  of  the  causation  of  disease 
by  polluted  water,  a  more  abstract  and  aesthetic  idea  is  involved 
in  consciously  taking  any  impurity  into  the  system.  The  in- 
stincts of  man,  as  well  as  of  most  animals,  revolt  at  it.  These 
inborn  instincts,  which  constitute  the  sanitary  conscience,  as 
Soyka  says,  demand  purity  of  food  and  water,  as  they  insist  on 
cleanliness  of  the  body,  of  clothing,  and  of  the  dwelling. 

STORAGE    AND    PURIFICATION    OF   WATER. 

Wherever  a  large  supply  of  water  is  needed,  unless  drawn 
direct  from  a  wTell  or  spring,  or  pumped  directly  from  its  source, 
arrangements  for  storage  are  necessary.  Cisterns  and  large 
reservoirs  are  made  use  of  for  this  purpose.  River-water,  espe- 
cially, requires  a  period  of  rest  in  a  storage  reservoir  in  order  to 
allow  deposition  of  the  large  amount  of  suspended  matter  in  it. 
Prolonged  storage  also  gives  opportunity  for  the  conversion  of 
possibly  deleterious  organic  compounds  into  simple  and  perhaps 
harmless  combinations.  Usually,  in  an  elaborate  system  of 
water-works,  a  series  of  reservoirs  is  built,  in  which  the  water  is 
stored  successively,  so  that  before  its  final  distribution  through 
the  street-mains  it  has  become  quite  clear  and  pure.  Filtration 
on  a  large  scale  is  also  used  in  connection  with  storage  reservoirs 
in  order  to  secure  greater  purity  of  the  water. 

In  the  distribution  of  water,  care  should  be  taken  that  nothing 
deleterious  is  taken  up  by  the  water  in  its  passage  through  the 
pipes.  Lead  poisoning  is  not  infrequent  from  drinking-water  that 
has  passed  through  a  long  reach  of  lead  pipe,  or  which  has  been 
standing  in  a  vessel  lined  with  lead.  Tanks  and  storage  cisterns 
should  therefore  not  be  lined  with  lead,  and  the  use  of  lead  pipe 
in  the  supply  service  should  be  avoided  as  much  as  possible. 
Fortunately,  most  natural  waters  possess  a  considerable  propor- 
tion of  carbon  dioxide,  which  forms  with  the  lead  an  almost 
insoluble  carbonate  of  lead.    This  carbonate  of  lead  is  deposited 


68  TEXT-BOOK  OF  HYGIENE. 

on  the  inside  of  the  pipes,  and  protects  both  the  pipes  against 
erosive  action  from  other  constituents  of  the  water,  and  also 
prevents  the  contamination  of  the  water  by  the  lead.  An  excess 
of  carbon  dioxide  in  the  water  renders  this  deposit  soluble,  and 
may  cause  serious  poisoning.  Any  water  which  is  shown  by 
analysis  to  contain  over  1  milligramme  of  lead  per  100,000  is 
dangerous,  and  should  be  rejected. 

Owing  to  the  possibility  of  defilement  of  the  water  from 
improper  construction  of  hydrants,  all  outdoor  hydrants  should 
be  discouraged  as  much  as  possible,  and  should  be  replaced  by  a 
simple  tap-cock  indoors.  The  pipes  should  also  be  laid  deep 
enough  under-ground,  or  otherwise  protected  against  freezing  in 
winter. 

A  number  of  methods,  all  more  or  less  efficient,  have  been 
introduced  to  purify  water  when  it  needs  purification  before 
being  fit  for  use.  These  methods  either  comprise  filtration  or 
seek  to  purify  the  water  without  the  aid  of  this  process.  One 
of  the  methods  of  purification  without  filtration  consists  in 
exposing  the  water  to  the  air  in  small  streams.  This  was  pro- 
posed by  Lind  more  than  a  century  ago,  and  has  since  been 
frequently  revived.  The  water  is  passed  through  a  sieve,  or  a 
perforated  tin  or  wooden  plate,  so  as  to  cause  it  to  fall  for  a 
distance  through  the  air  in  finely-divided  currents.  By  this 
process  sulphuretted  hydrogen,  offensive  organic  vapors,  and 
possibly  dissolved  organic  matters  are  removed.  This  process 
has  been  used  in  Russia  on  a  large  scale. 

By  boiling  and  agitatjon,  carbonate  of  lime,  sulphuretted 
hydrogen,  and  organic  matter  are  removed  or  rendered  innocuous. 
Vegetable  germs  are  usually  destroyed,  although  Tyndall  has 
shown  that  some  bacterial  germs  withstand  a  temperature  higher 
than  that  of  boiling  water.  Pathogenic  germs  are,  however,  all 
destroyed  by  boiling  water  acting  upon  them  for  ten  minutes,  as 
shown  by  Dr.  G.  M.  Sternberg.1 

As  has  already  been  mentioned,2  alum  is  one  of  the  readiest 

1  Report  of  Committee  on  Disinfectants,  1888.  *  See  page  59. 


STORAGE    AND    PURIFICATION    OF   WATER!  69 

and  most  efficient  means  of  removing  suspended  matters  from 
water. 

Permanganate  of  potassium  is  sometimes  used  to  purify 
water  containing  considerable  organic  matter.  The  perman- 
ganate rapidly  oxidizes  the  organic  matter,  and  is  believed  to 
render  it  harmless.  There  is  no  certainty,  however,  that  the 
germs  of  specific  diseases  are  destroyed  by  the  action  of  this 
salt,  in  the  proportion  in  which  it  could  be  used  for  the  purposes 
of  water  purification. 

A  yellow  tint  is  given  to  the  water  by  the  permanganate, 
which  is  due  to  finely-divided  peroxide  of  manganese.  This 
does  no  harm,  but  is  unpleasant. 

Water  unfitted  for  use  by  organic  matter  is  sometimes 
rendered  usable  by  infusing  certain  vegetable  astringents  in  it. 
Thus,  it  is  said  that  in  certain  parts  of  China,  where  the  water 
contains  large  quantities  of  organic  matter,  the  inhabitants  drink 
water  only  in  the  form  of  tea.  The  tannin  of  the  tea-leaves 
precipitates  the  suspended  matters  and  renders  the  water  fit  for 
use.  Mixing  the  water  with  red  wine,  which  is  astringent,  has 
the  same  effect.1 

Filtration  is  an  efficient  means  of  removing  suspended 
matters.  Charcoal,  sand,  gravel,  and  spongy  iron  are  used  as 
filtering  material.  A  most  economical  filter  is  one  made  of  fine, 
clean  sand,  above  which  layers  of  gravel  of  a  gradually-increasing 
size  are  placed.  The  coarser  particles  of  suspended  matter  are 
arrested  before  the  sand,  which  removes  most  of  the  coloring 
and  organic  matters,  is  reached. 

Filters  easily  become  fouled  by  the  matters  arrested  in  the 
interstices  of  the  filtering  material,  and  hence  require  frequent 
renewal  or  cleansing.  A  cheap  and  efficient  filter  is  made  by 
placing  a  sheet  of  druggists'  filtering-paper  in  a  glass  funnel 
and  filtering  the  water  through  it.  A  new  and  clean  sheet  of 
paper  should  be  used  every  day. 

M.  Chamberland  has  invented  a  filter  which  is  said  to  be 

1  Champouillon,  quoted  in  Med.  and  Surg.  Hist,  of  the  War,  part  ii  med.  vol.,  p.  613. 


7U  TEXT-BOOK   OF    HYGIENE. 


absolutely  germ-proof,  but  this  power  is  not  permanent,  as  after 
a  week  micro-organisms  pass  through  the  filtering  material. 
The  same  is  true  of  all  other  filters  hitherto  invented. 


TESTS   FOR   IMPURITIES   IN   WATER. 

Accurate  and  reliable  quantitative  analyses  of  water  can 
only  be  made  by  chemists  of  experience.  Every  intelligent 
person  should,  however,  know  how  to  determine  the  presence  or 
absence  of  suspected  impurities.  The  following  methods  are 
simple,  and  easily  carried  out: — 

The  color,  transparency,  and  odor  of  water  are  determined 
by  the  unaided  senses.  As  a  standard  for  comparison  in  making 
the  color  test,  pure,  distilled  water  may  be  used.  Two  tubes  of 
clear,  white  glass,  61  centimetres  long,  are  filled  with  distilled 
water  and  with  the  specimen  to  be  tested,  and  placed  side  by  side 
upon  a  sheet  of  white  paper.  The  tops  of  the  tubes  are  covered 
with  little  squares  of  clear  glass.  The  color  is  noted  by  com- 
paring the  tints  of  the  water  in  the  two  tubes.  The  same 
procedure  may  be  used  to  determine  the  transparency  of  the 
water. 

While  the  color  and  turbidity  show  impurities,  these  are 
not  necessarily  prejudicial  to  health;  on  the  other  hand,  the 
clearest  and  most  sparkling  water  may  contain  so  much  poisonous 
matter  as  to  be  positively  dangerous.  The  odor  of  the  water  is 
best  ascertained  by  heating  a  small  quantity  in  a  narrow-necked 
flask  to  40°  to  45°  C.  (104°  to  113°  F.),  and  then  taking  a  few 
strong  whirls  at  the  flask.  The  odor  may  or  may  not  indicate 
the  presence  of  deleterious  substances. 

The  chemical  examination  of  a  water  for  sanitary  purposes, 
short  of  a  complete  analysis,  comprises  the  determination  of  the 
presence  or  absence  of  suspected  impurities;  in  other  words,  it 
may  be  termed  a  qualitative  analysis.  In  some  cases  an  approxi- 
mate quantitative  examination  may  also  be  made  with  little 
more  trouble  and  skill. 


TESTS   FOR   IMPURITIES   IN    WATER.  71 

The  examination  may  be  divided  into  the  following  pro- 
cedures : — 

1.  The  determination  of  the  total  residue. 

2.  The  determination  of  the  presence  of — 

(a)  Organic  matter. 
(6)  Chlorides. 

(c)  Nitrogen  compounds. 

(d)  Mineral  poisons. 

Determination  of  Total  Solids. — Examination  of  the  public 
water-supply  of  eight  large  cities  in  the  United  States  shows 
that  the  total  solid  residue  varies  from  6  to  16  parts  in  100,000. 
The  total  solids  of  a  good  drinking-water  should  not  exceed 
25  to  30  parts  per  100,000,  although  a  larger  quantity  may  be 
present  without  being  harmful.  The  method  of  determining 
the  total  solids  is  to  evaporate  a  definite  quantity — say,  70  cubic 
centimetres  of  the  water — in  a  previously-weighed  platinum 
dish  to  dryness  over  a  water-bath.  The  dish  is  then  wiped  dry 
and  weighed  again.  The  difference  in  weight  between  the 
empty  dish  and  the  latter  with  the  dry  residue  represents  the 
proportion  of  the  latter  in  grains  per  gallon.  To  convert  this 
figure  into  parts  per  100,000  the  number  of  grains  per  gallon 
is  divided  by  .7.  For  example,  if  the  number  of  grains  of  solid 
residue  in  the  specimen  examined  is  22.4,  then 

22.4  -^-  .7  =  32  parts  per  100,000. 

Determination  of  Organic  Matter. — This  is  the  most  difficult 
test  to  apply  in  the  sanitary  examination  of  water.  While  it  is 
comparatively  easy  to  determine  the  presence  of  organic  matter, 
its  quantity  and  nature  are  exceedingly  complex  problems  to 
solve. 

The  presence  of  organic  impurity  in  water  may  be  detected 
by  the  permanganate-of-potash  test,  the  nitrate-of-silver  test, 
and  the  incineration  test.  Neither  of  these  processes  is  compe- 
tent to  differentiate  noxious  from  inoffensive  organic  matter. 
The  permanganate  test,  modified  by  Dr.  DeChaumont,  is  the 


72  TEXT-BOOK   OF   HYGIENE. 

one  usually  adopted.  The  process  is  as  follows:  To  250  cubic 
centimetres  of  the  water  to  be  examined  add  5  cubic  centimetres 
of  dilute  sulphuric  acid  (10  per  cent.)  in  a  clear,  white  glass 
flask.  Then  add  permanganate  of  potassium  solution  (395 
milligrammes  to  1  litre  of  distilled  water)  until  the  water  has 
taken  a  pink  tinge.  Heat  the  water  to  140°  F.  (60°  C),  adding 
permanganate  solution  if  the  color  disappears.  AVhen  the  tem- 
perature above  mentioned  is  reached  remove  the  flask  from  the 
burner,  and  add  permanganate  drop  by  drop  until  a  faint  pink 
color  is  obtained,  which  remains  permanent  for  ten  minutes. 
Read  off  the  number  of  cubic  centimetres  of  the  permanganate 
solution  used  as  required  for  total  oxidizable  matter.  As  the 
solution  of  permanganate  yields  in  presence  of  an  acid  0.1  of  a 
milligramme  of  oxygen  for  each  cubic  centimetre,  it  is  evident  that 
the  number  of  cubic  centimetres  of  solution  decomposed  has 
furnished  an  equal  number  of  tenths  of  a  milligramme  of  oxygen 
which  has  entered  into  other  combinations. 

But,  inasmuch  as  all  the  oxidizable  matter  in  the  water 
may  not  be  organic,  the  inorganic  oxidizable  matter  (nitrous 
acid)  must  be  separated.  This  is  done  by  first  boning  the  water 
with  sulphuric  acid,  as  above  (250  cubic  centimetres  +  5  cubic 
centimetres),  for  twenty  minutes,  to  remove  the  nitrous  acid. 
Then  allow  the  acidulated  water  to  cool  down  to  60  degrees 
and  add  the  permanganate  until  a  pink  color  is  obtained  for  ten 
minutes.  The  amount  of  permanganate  solution  used  gives  the 
number  of  milligrammes  of  oxygen  required  for  oxidizable 
organic  matter. 

Determination  of  Chlorides. — Chlorine,  or  its  compounds, 
when  present  in  drinking-water,  represent  generally  sewage 
pollution.  It  is  true  that  chlorine  may  be  in  excess  in  water, 
and  the  latter,  nevertheless,  be  entirely  free  from  sewage  or 
urine,  but  this  occurs  only  where  there  is  a  natural  deposit  of 
chlorine  compounds  in  the  soil  from  which  the  supply  is  drawn. 
If  communication  with  the  sea  or  salt-deposits  is  excluded,  the 
chlorine  may  be  assumed  to  be  due  to  the  inflow  of  sewage. 


TESTS   FOR   IMPURITIES   IN   WATER.  73 

Especially  is  this  the  case  if  the  test  for  organic  matter  has  given 
positive  results.  The  proportion  of  chlorine  may  be  estimated 
thus:  Place  70  cubic  centimetres  of  the  water  into  an  evapo- 
rating dish,  and  add  a  small  fragment  of  neutral  chromate  of 
potash.  Then,  by  means  of  a  pipette  graduated  to  tenths  of  a 
cubic  centimetre,  standard  solution  of  nitrate  of  silver1  should 
be  allowed  to  drop  into  the  water  until  the  red  color  produced 
remains  permanent.  The  number  of  cubic  centimetres  of  the 
silver  solution  required  to  produce  the  permanent  red  tint  is 
equivalent  to  the  number  of  grains  of  chlorine  per  gallon,  which, 
if  divided  by  .7,  gives  the  parts  per  100,000. 

Another  method  of  determining  the  presence  of  chlorine  or 
chlorides  is  as  follows:  Acidulate  about  16  cubic  centimetres  of 
the  water  to  be  tested  with  pure  nitric  acid,  and  add  a  few  drops 
of  a  solution  of  nitrate  of  silver  (1.5  grammes  to  32  cubic  cen- 
timetres of  distilled  water).  A  white  precipitate,  gradually 
changing  to  gray,  is  produced  if  chlorides  are  present.  The 
degree  of  cloudiness  produced  will  indicate  approximately  the 
amount  of  chlorides:  ';  1 .5  parts  of  chlorine  per  100,000  give 
a  haze;  5.7  parts  per  100,000  give  a  marked  turbidity;  14  parts 
per  100,000,  considerable  precipitate."  If  the  chlorine  is  found 
by  this  test  to  exceed  1.5  parts  per  100,000,  the  source  of  the 
contamination  should  be  searched  for.  If  drainage  from  a  cess- 
pool is  suspected,  a  quantity  of  salt  water  may  be  thrown  into 
it,  and  the  water  again  tested  after  an  interval  of  four  hours  to 
see  whether  the  chlorine  has  increased. 

Determination  of  Nitrites  and  Nitrates. — The  presence  of 
these  nitrogen  compounds  in  drinking-water  should  excite  sus- 
picion of  sewage  contamination.  They  are  the  resultants  of 
oxidation  of  nitrogenous  organic  matter,  and,  although  water 
containing  them  is  not  necessarily  dangerous,  their  presence 
should  render  a  thorough  examination  of  the  source  of  supply 
imperative. 

1  Standard  Solution  of  Nitrate  of  Silver.— Dissolve  4.79  grammes  of  crystallized  nitrate 
of  silver  in  1  litre  of  distilled  water.  One  cubic  centimetre  of  this  solution  precipitates  1  milli- 
gramme of  chlorine. 


74  TEXT-BOOK   OF   HYGIENE. 

The  readiest  method  of  detecting  nitrates  and  nitrites  in 
water  is  by  the  pyrogallol  test.  This  may  be  performed  as  fol- 
lows :  Put  2  cubic  centimetres  of  pure  sulphuric  acid  in  a  small 
test-tube  and  add  1  cubic  centimetre  of  the  water  to  be  tested. 
To  this  mixture  is  added  1  drop  of  a  solution  of  pyrogallol 
(65  centigrammes  to  30  cubic  centimetres)  in  distilled  water, 
acidulated  with  2  drops  of  sulphuric  acid.  The  water  becomes 
colored  a  dark  amethyst  or  wine  brown  if  the  salts  are  present. 
The  depth  of  color  indicates  approximately  the  amount  of  the 
impurity. 

The  following  test  for  nitric  acid  or  nitrates  may  also  be  used : 
A  small  quantity  of  the  water  is  evaporated  to  dryness,  and  a 
few  drops  of  a  solution  of  carbolic  acid  in  4  parts  of  con- 
centrated sulphuric  acid  and  2  parts  of  distilled  water  added 
to  the  residue.  If  nitric  acid  is  present,  a  brownish-red  color 
results,  which  turns  green  and  then  yellow  upon  the  addition  of 
ammonia. 

Nitrous  acid  or  nitrites  will  give  a  reaction  with  iodide  of 
potassium  and  starch ;  350  to  600  cubic  centimetres  of  water 
in  a  flask  are  acidulated  with  a  few  drops  of  dilute  sulphuric 
acid,  and  a  little  solution  of  iodide  of  potassium  added.  About 
2  grammes  of  freshly-prepared  starch  are  added  and  the  mixture 
shaken.  If  nitrous  acid  is  present,  the  iodide  is  decomposed, 
setting  free  the  iodine,  which  combines  with  the  starch,  causing 
a  blue  color.     The  test  is  a  very  delicate  one. 

Ammonia. — The  presence  of  this  is  determined  by  Nessler's 
reagent,1  as  follows:  100  cubic  centimetres  of  the  water  to  be 
examined  is  treated  with  0.5  cubic  centimetre  of  caustic  soda 
solution  and  1  cubic  centimetre  of  carbonate  of  soda  solution 
to  precipitate  the  earthy  salts.  After  the  precipitate  has  sub- 
sided, 1  cubic  centimetre  of  Nessler's  reagent  is  added.  If 
ammonia  is  present  the  water  takes  a  yellowish  tint. 

1  Nessler's  Reagent. — Dissolve  by  heating  and  stirring  35  grammes  of  potassium  iodide 
and  13  grammes  of  mercuric  chloride  in  800  cubic  centimetres  of  distilled  water.  Add  gradually  a 
cold  aqueous  saturated  solution  of  mercuric  chloride  until  the  red  color  produced  just  begins 
to  be  permanent ;  160  grammes  of  solid  caustic  potash  are  then  added  to  the  mixture  which  is  to 
be  diluted  with  distilled  water  until  it  exactly  measures  one  litre. 


TESTS   FOR    IMPURITIES   IN   WATER. 


75 


Determination  of  Mineral  Poisons. — Of  these  the  most 
important  are  lead,  copper,  zinc,  and  arsenic.  The  presence  of 
any  of  these  in  even  the  smallest  quantity  is  dangerous,  and,  if 
constant,  the  water  so  contaminated  should  not  be  used  for 
drinking  purposes. 

In  order  to  detect  lead  250  cubic  centimetres  of  the  water 
is  first  treated  with  hydrochloric  acid,  and  then  sulphuretted 
hydrogen  (in  aqueous  solution)  is  added.  If  a  brownish  or 
black  precipitate  results,  either  lead  or  copper  may  be  present. 

On  filtering  the  water,  dissolving  the  residue  in  hot,  diluted 
nitric  acid,  and  adding  a  solution  of  potassium  bichromate,  a 
yellow  precipitate,  soluble  in  caustic  potash,  is  thrown  down  if 
lead  is  present.  If  the  precipitate  produced  by  sulphuretted 
hydrogen  is  dissolved,  as  above,  and  ammonia  added,  a  blue 
color  is  produced  in  the  presence  of  copper.  To  detect  zinc  the 
sulphuretted  hydrogen  precipitate  is  treated  with  caustic  soda, 
again  filtered,  and  sulphuretted  hydrogen  added  to  the  filtering 
liquid.     A  white  precipitate  indicates  the  presence  of  zinc. 

Arsenic  is  detected  by  Marsh's  test.  Mr.  A.  J.  Cooper  has 
prepared  the  following  table  showing  the  accuracy  of  certain 
tests  employed  for  the  determination  of  poisonous  metals  in 
drinking-water : — 


Table  V. 

Metal. 

Reagent. 

Depth  of  Liquid,  3% 
Inches. 

Depth  of  Liquid,  14^ 

Inches  (cylinder  inclosed 

in  opaque  tube). 

Copper      .     .     . 
Copper      .     .     . 
Copper      .     .     . 
Zinc      .     .     .     . 
Arsenic     .     .     . 
Lead     .     .     .     . 
Lead     .     .     .     . 

K4Cy6Fe 
NH4HO 

H2S 
NH4HS 

H2S 
K2Cr04 

H2S 

1  part  of  metal  detected  in 
4,000,000  of  water. 
1,000.000  " 
4,150,000  " 
2,500,000  " 
3,600,000  " 
4,000,000  " 
100,000,000  " 

1  part  of  metal  detected  in 
11,750,000  of  water. 
1,950,000  " 
15,660,000  " 

7,520,000  "         " 
5,875,000  " 
196,000,000  " 

In  making  the  tests  a  tall  glass  is  used,  and  the  formation 
of  the  precipitate  observed  by  looking  down  perpendicularly 
through  the  column  of  liquid  of  3f  inches  (95  millimetres)  and 
14|  inches  (368  millimetres)  respectively. 


76  TEXT-BOOK  OF   HYGIENE. 


SIGNIFICATION   OF   THE   VARIOUS   IMPURITIES   INDICATED    BY   THE 
FOREGOING   TESTS. 

The  following  summary  gives,  briefly,  the  inferences  that 
may  be  drawn  from  the  result  of  the  foregoing  tests1 : — 

"If  chlorine  be  present  inconsiderable  quantity  it  either 
comes  from  strata  containing  chloride  of  sodium  or  calcium, 
from  impregnation  of  sea-water,  or  from  admixture  of  liquid 
excreta  of  men  and  animals.  In  the  first  case  the  water  is 
often  alkaline  from  sodium  carbonate  ;  there  is  an  absence,  or 
nearly  so,  of  oxidized  organic  matters,  as  indicated  by  nitric  and 
nitrous  acids  and  ammonia,  and  of  organic  matter;  there  is 
often  much  sulphuric  acid.  If  it  be  from  calcium  chloride  there 
is  a  large  precipitate  with  ammonium  oxalate  after  boiling.  If 
the  chlorine  be  from  impregnation  with  sea-water,  it  is  often  in 
very  laige  quantity ;  there  is  much  magnesia,  and  little  evidence 
of  oxidized  products  from  organic  matters.  If  from  sewage  the 
chlorine  is  marked,  and  there  is  coincident  evidence  of  nitric  and 
nitrous  acids  and  ammonia,  and  if  the  contamination  be  recent 
of  oxidizable  organic  matters. 

"Ammonia  is  almost  always  present  in  very  small  quan- 
titv,  but  if  it  be  in  large  enough  amount  to  be  detected  without 
distillation  it  is  suspicious.  If  nitrates,  etc.,  be  also  present,  it 
is  likely  to  be  from  animal  substances,  excreta,  etc.  Nitrates 
and  nitrites  indicate  previously-existing  organic  matters,  prob- 
ably animal,  but  nitrates  may  also  arise  from  vegetable  matter, 
although  this  is  probably  less  usual.  If  nitrites  largely  exist  it 
is  generallv  supposed  that  the  contamination  is  recent ;  the  co- 
incidence of  easily-oxidized  organic  matters,  of  ammonia,  and 
of  chlorine  in  some  quantity,  would  be  in  favor  of  an  animal 
origin.  If  a  water  gives  the  test  of  nitric  acid,  but  not  of 
nitrous  acid,  and  very  little  ammonia,  either  potassium,  sodium, 
or  calcium  nitrate  is  present,  derived  from  soil  impregnated 
with  animal  substances  at  some  anterior  date.     If  nitrites  are 

1  Parkes'  Hygiene,  vol.  i,  p.  79. 


SIGNIFICATION    OF    VARIOUS   IMPURITIES.  77 

present  at  first,  and  after  a  few  days  disappear,  this  arises  from 
continued  oxidation  into  nitrates ;  if  nitrates  disappear  it  seems 
probable  this  is  caused  by  the  action  of  bacteria  or  other  low 
forms  of  life.  Sometimes  in  such  a  case  nitrites  may  be  formed 
from  the  nitrates.  Lime  in  large  quantity  indicates  calcium  car- 
bonate if  boiling  removes  the  lime,  sulphate  or  chloride  or  ni- 
trate if  boiling  has  little  effect.  Testing  for  calcium  carbonate 
is  important  in  connection  with  purification  with  alum.  Sul- 
phuric acid  in  large  quantity,  with  little  lime,  indicate  sulphate 
of  sodium,  and  usually  much  chloride  and  carbonate  of  sodium 
are  also  present,  and  on  evaporation  the  water  is  alkaline. 
Large  evidence  of  nitric  acid,  with  little  evidence  of  organic 
matter,  indicates  old  contamination ;  if  the  organic  matter  be 
large,  and  especially  if  there  be  nitrous  acid  as  well  as  nitric 
present,  the  impregnation  is  recent." 

i 

THE    BIOLOGICAL  OR   BACTERIOLOGICAL   EXAMINATION   OF   DRINKING- 
WATER. 

Since  the  development  of  the  methods  of  cultivation  of 
micro-organisms  by  Koch  and  his  pupils,  and  their  employment 
for  the  study  of  water  pollution  by  Meade  Bolton,  Wolffhiigel 
and  Riedel,  Percy  Frankland,  Prudden,  and  others,  and  the  un- 
satisfactory results  of  chemical  analysis,  some  sanitarians  have 
expressed  the  conviction  that  the  biological  method  is  the  only 
exact  one  for  determining  water  pollution  from  a  sanitary  point 
of  view.  While  this  may  be  conceded,  it  is  also  true  that  very 
few  health  officers  are  competent  to  give  an  expert  opinion  upon 
the  nature  of  the  organisms  which  may  be  found  in  the  water 
examined.  It  requires  but  little  technical  skill  to  make  cultiva- 
tions of  bacteria  from  samples  of  water,  but  only  an  expert 
bacteriologist  may  safely  pronounce  upon  the  nature  of  the 
organisms  constituting  the  various  colonies  which  develop  upon 
the  nutritive  gelatin.  Just  as  the  mere  presence  of  organic 
matter  as  determined  by  the  chemist  is  not  indicative  of  a  dan- 
gerous quality  in  the  water  unless  the  kind  of  organic  matter 


78 


TEXT-BOOK   OF    HYGIENE. 


and  its  derivation  be  also  specified,  so  likewise  the  presence  of 
bacteria  alone  is  of  small  significance ;  the  danger  consists  not 
in  bacteria,  but  in  certain  kinds  of  bacteria.  The  differential 
diagnosis  is  possible  only  to  the  trained  bacteriologist. 

While,  as  stated,  a  positive  decision  as  to  the  sanitary  value 
of  a  water  may  often  be  impossible,  there  are  certain  chemical 
and  microscopical  features  which  stamp  a  water  as  good  or  bad. 
Dr.  DeChaumont  gives  an  approximate  valuation  which  may 
often  serve  as  a  useful  guide.1 

He  classifies  water  under  the  four  heads  of  Pure  and 
Wholesome  Water,  Usable  Water,  Suspicious  Water,  and  Im- 
pure Water.  The  characters  of  these  waters  are  arranged  in  a 
series  of  tables,  the  essential  details  of  which  are  given  in 
Table  VI. 

Table  VI. 


Pure 

Usable 

Suspicious 

Impure 

Water. 

Water. 

Water. 

Water. 

Chemical 

Constituents. 

I. 

II. 

in. 

IV. 

Parts  in  100,000. 

Parts  in  100,000. 

Parts  in  100,000. 

Parts  in  100,000. 

Chlorine  in  solution  . 

Under  1.4000 

Under  4.2857 

4-7 

Above  7.1428 

Solids           "   total     . 

"       7.1428 

"     42.8571 

43-71 

"     71.4285 

"                "   volatile 

"      1.4000 

"      4.2857 

4-7 

"      7.1428 

Ammonia,  free  or  sa- 

line     

"       0.0020 

"       0.0050 

0.0050-0.0100 

"      0.0100 

Ammonia,  albuminoid 

"       0.0050 

"       0.0100 

0.0100-0.0125 

"      0.0125 

Nitric  acid  in  nitrates 

"      0.0323 

"       0.5000 

0.5-1.0 

"       1  0000 

"         "  nitrites 

Nil. 

Nil. 

0.0500 

"       0.0500 

Nitrogen  in  nitrates    . 

"      0.0140 

"      0.1129 

0.1243-0.2373 

"      0  2415 

Total  nitrogen  .     .     . 

"      0.0230 

"       0.1252 

0.1255-0.2465 

"       0.2(501 

Oxygen   absorbed  by 

permanganate    and 

acid  within  half  an 

hour  at  140°  F.  .     . 

"      0.0250 

"      0.1000 

0.1000-0.1500 

"      0.1500 

Total  hardness  .     .     . 

"      8.5 

"    17.3 

Above  17.0 

"    28.5 

Permanent  hardness  . 

"       3.0 

"      5.7 

"      5.7 

"      8.7 

Phosphoric     acid     in 

phosphates     .     .     . 

Traces. 

Traces. 

Heavy  traces. 

Heavy  traces. 

Sulphuric  acid  in  sul- 

a 

Under  3.000 

Above  3.000 

Above  4.2857 

Heavy  metals    .     .     . 

Nil. 

Traces. 

Traces. 

/  Any  except 
(       iron. 

Hydrogen  sulphide    . 

" 

Nil. 

Nil. 

Present. 

Alkaline  sulphides 

K 

1  Parkes'  Hygiene,  vol.  i,  pp.  103-106. 


EXAMINATION    OF    DRINKING-WATER. 


79 


Physical  Characters. 

No.  I.  Colorless,  or  bluish  tint ;  trans- 
parent, sparkling,  and  well  aerated  ;  no 
sediment  visible  to  naked  eye  ;  no  smell ; 
taste  palatable. 

No.  II.  Colorless,  or  slightly  greenish 
tint ;  transparent,  sparkling,  and  well 
aerated  ;  no  suspended  matter,  or  else 
easily  separated  by  coarse  filtration  or 
subsidence  ;  no  smell ;  taste  palatable. 

No.  III.  Yellow,  or  strong,  green 
color  ;  turbid  ;  suspended  matter  con- 
siderable ;  no  smell,  but  any  marked 
taste. 

No.  IV.  Color,  yellow  or  brown  ;  tur- 
bid, and  not  easily  purified  by  coarse 
filtration  ;  large  amount  of  suspended 
matter  ;  any  marked  smell  or  taste. 


Microscopical  Characters. 
No.    I.     Mineral   matter ;    vegetable 
forms  with  endochrome ;  large  animal 
forms  ;  no  organic  debris. 

No.  II.     Same  as  No.  I. 


No.  III.  Vegetable  and  animal  forms 
more  or  less  pale  and  colorless  ;  organic 
debris  ;  fibres  of  clothing,  or  other  evi-_ 
dences  of  house-refuse. 

No.  IV.  Bacteria  of  any  kind ;  fungi ; 
numerous  vegetable  and  animal  forms 
of  low  types  ;  epithelia,  or  other  animal 
structures  ;  evidences  of  sewage  ;  ova 
of  parasites,  etc. 


[The  following  works  are  recommended  to  those  desiring 
fuller  information  upon  the  subjects  embraced  in  the  foregoing 
chapter : — 

Water  Supply,  by  Wm.  Ripley  Nichols,  N.  Y.,  1884.— A  Guide  to 
the  Microscopic  Examination  of  Drinking-Water,  by  J.  D.  MacDonald, 
R.N.F.R.S. — Sanitary  Examinations  of  Water,  Air,  and  Food,  by  Fox. — 
Report  of  the  Committee  on  Water  Pollution,  Public  Health,  vol.  xiv. 
Zeitschr.  f.  Hygiene,  vol.  i,  by  Bolton. — Prudden  in  N.  Y.  Medical 
Record,  1887. — Arb.  aus  d.  Reichsgesundlieitsamte,  I,  Wolffkugel  and 
RiedelJ 


CHAPTER  III. 

Food. 

In  order  to  preserve  health  and  vigor  it  is  necessary  for 
animal  beings  to  consume  at  intervals  a  sufficient  quantity  of 
substances  known  as  foods.  Alimentary  substances,  or  foods,. 
may,  therefore,  be  briefly  defined  as  materials  which,  taken  into 
the  body  and  assimilated,  sustain  the  processes  of  life,  promote, 
growth,  or  prevent  destruction  of  the  organized  constituents  of 
the  body. 

QUANTITY    AND    CHARACTER    OF   FOOD    NECESSARY. 

It  has  long  been  known,  as  the  result  of  the  empirical 
observation  of  feeding  large  bodies  of  people,  that  the  various- 
proximate  principles  composing  the  tissues  must  be  combined  in 
certain  definite  proportions  in  the  food  in  order  to  preserve  the 
normal  degree  of  health  and  vigor  of  the  body.  Within  a 
comparatively  recent  period  physiologists  have  made  experi- 
ments upon  animals  and  human  beings  which  have  led  to  the 
same  conclusions,  and  have  enabled  these  proportions  to  be 
fixed  with  more  or  less  exactness. 

Considering  man  as  an  omnivorous  animal,  it  may  be  laid 
down  as  an  invariable  rule  that  the  following-  four  alimentary 
principles  are  necessary  to  his  existence.1  Neither  of  these 
principles  can  be  dispensed  with  for  a  prolonged  period  without 
illness  or  death  resulting. 

1.  Water. — This  must  be  supplied  in  sufficient  quantity 
to  permit  the  interchange  of  tissue  to  be  earned  on  in  the  body. 

2.  Salts. — Inorganic    compounds    of    various    kinds    are 

1  Physiologie,  Landois,  2te  Aufl.,  p.  448. 

(81) 


82  TEXT-BOOK    OF    HYGIENE. 

necessary  to  the  preservation  and  proper  construction  of  the 
tissues.  They  are  all  found  in  sufficient  quantities  in  the 
various  alimentary  substances  consumed  by  man  and  the  lower 
animals.  A  deficiency  of  inorganic  constituents  in  the  food  is 
followed  by  disease. 

3.  Proteids. — Organic  nitrogenous  material,  either  animal 
or  vegetable,  is  a  necessary  constituent  of  the  food  of  man. 
Continued  existence  is  impossible  without  a  sufficient  supply  of 
nitrogenous  substances. 

4.  Fats  or  Carbohydrates. — The  organic  non-nitrogenous 
or  carbonaceous  principles  of  food  are  also  necessary  to  the 
continuance  of  health.  They  are  supplied  either  by  fats  or  by 
carbohydrates  (sugar,  starch,  etc.).  which  may,  within  certain 
limits,  be  used  as  substitutes  for  each  other.  Voit  has  shown 
that  1  7  parts  by  weight,  of  starch,  is  equivalent  as  carbonaceous 
or  oxidizable  food  to  10  parts  of  fat. 

The  physiology  of  nutrition  has  been  very  carefully  studied 
by  a  large  number  of  experimental  physiologists,  who  have 
arrived  at  conclusions  differing  widely  from  those  generally 
accepted  twenty-five  years  ago.  The  division  of  foods  into 
plastic  and  respiratory  foods,  or,  in  a  general  way,  into  proteids 
or  muscle-builders,  and  fats  and  carbohydrates,  or  oxidizing 
foods,  is  now  no  longer  recognized  in  science.  It  has  been 
established  that  proteid  tissues  are  not  alone  the  result  of  proteid 
food,  and  that  the  accumulation  of  fat  in  the  body  is  not  altogether 
due  to  the  excessive  consumption  of  fats  and  carbohydrates.  It 
has  been  further  shown,  contrary  to  the  general  belief,  that  the 
nitrogenous  or  proteid  tissues  are  not  used  up  during  hard  labor 
any  faster  than  when  at  perfect  rest,  but  that,  on  the  contrary, 
increased  muscular  exertion  is  attended  by  increased  consump- 
tion of  stored-up  fat. 

These  facts  have  led  to  a  modification  of  the  standard 
dietaries  formerly  employed.  At  present  the  standards  of  the 
quantity*  of  food  principles  required  to  maintain  equality  between 
bodily  income  and  expenditure  are  those  calculated  by  Professor 


QUANTITY   AND    CHARACTER    OF    FOOD    NECESSARY. 


83 


Yoit,  after  many  experiments  upon  human  beings  and  the  lower 
animals.     These  standards  are  as  follow  : — 


Table  VII. 

ADULT   MALE   OP    AVERAGE    WEIGHT. 


At  Rest. 

Moderate  Labor. 

Severe  Labor. 

Proteicls      .... 

Fats 

Carbohydrates    .     . 

110  grammes 
50       "' 
450       " 

118  grammes 
50       " 
500       " 

145  grammes 
100       " 
500       " 

As  the  average  weight  of  women  is  less  than  that  of  men, 
a  reduction  of  from  15  to  20  per  cent,  in  the  various  food  prin- 
ciples may  be  made  for  the  female  ration. 

The  relative  proportion  of  nitrogenous  to  non-nitrogenous 
principles  in  this  ration  is  about  1  to  5.  In  the  older  diet 
standards,  e.g.,  Moleschott's,  the  proportion  of  nitrogenous  to 
non-nitrogenous  principles  is  much  larger,  being,  for  a  man  at 
moderate  labor,  proteids,  130  grammes;  fats,  84  grammes;  and 
carbohydrates,  404  grammes,  or  about  1  to  3.75. 

While  from  ignorance,  or  motives  of  economy,  many  men 
sustain  life  and  preserve  health  at  hard  labor  on  rations  varying 
considerably  from  the  standard  above  given,  it  is  probable  that, 
all  things  being  considered,  the  most  perfect  physiological  ration 
would  also  be  the  most  economical.  Thus,  Professor  Vaughan 
proposes  a  daily  ration  consisting  of  bread,  cod-fish,  lard,  potatoes, 
bacon,  beans,  milk,  sugar,  and  tea  in  such  proportions  as  to  fur- 
nish 123  grammes  proteids,  70  grammes  fats,  and  550  grammes 
carbo-hydrates.  The  total  cost  or  money  value  of  this  ration  at 
present  prices  is  about  thirteen  cents.  In  actual  food  value  it 
is  not  inferior  to  the  daily  fare  of  the  habitue  of  Delmonico's. 

The  above  standard  diet-tables  give  the  relative  proportions 
of  food  principles  in  terms  of  their  proximate  chemical  composi- 
tion. In  practice  it  is  very  necessary  to  choose  such  food  ma- 
terials as  will  represent  approximately  the  proximate  principles 


84  TEXT-BOOK   OF    HYGIENE. 

required.  The  following  tables  give  the  approximate  value  in 
proteids,  fats,  carbohydrates,  and  salts  of  a  number  of  articles 
used  as  food: — 

Table  VIII. 

ANIMAL   FOODS. 


-    . 

0 

O 

5  s 
*°  0 

t-  4J 

S  r£+i 

^2 

- 

S  a>  M 

c  3 

m  £ 

sr.  0  x 

5  ^S 

Articles. 

*i  <s 

4J    O 

"7r  S> 

x. 

S  uS 

£55 

fc| 

O 

a 

2  '=*•-  is 
9 £  £^ 

0 

Ph 

*i 

72.25 

21.39 

5.19 

1.17 

1: 

0.4 

Ox-heart  (fat  animal)  .... 

70.08 

21.51 

7.47 

0.16 

0.78 

1: 

0.6 

Fat  veal 

72.31 

75.99 

18.88 
18.11 

7.41 

5.77 

0.07 

1.33 
1.33 

1: 
1: 

0.7 

Moderately  fat  mutton     .    .    . 

0.6 

72.57 

19.91 

6.81 

1.10 

1 

0.6 

62.58 
74.16 
75.76 

74.27 

22.32 
23.34 
19.77 
21.71 

8.68 
1.13 
1.92 
2.55 

0^19 

1.42 
0.46 

6.42 
1.18 
1.13 
1.01 

1: 
1: 

1 

1 

0.7 

0.1 

0.2 

0.2 

48.70 

15.93 

26.33 

6.38 

2.66 

1 

3.3 

Beef-extract 

21.70 

60  79 

17.51 

76.22 

19.72 

1.42 

1.27 

1.37 

1 

0.2 

75.10 

70.82 
80.92 

22.14 
22.65 
17.09 

1.00 
3.11 
0.35 

0.76 
2.33 

1.00 
1.09 
1.64 

1 

1 
1 

0.1 

Wild  duck 

0.3 

0.0 

80.71 

10.11 

7.11 

2.07 

1 

0.0 

22.23 

0.47 

1.71 

1 

0.0 

68.27 
79.91 
76.38 
76.97 

77.45 
86  14 
89.69 

23.42 
13.57 
13.10 
20.61 
20.11 
11.94 
4.95 
31.90 
19.59 
(8  albumen) 

6.76 
5.02 
4.57 
1.09 
0.69 
0.25 
0.37 

14.14 
5.60 

13.14 

a  39 

4.67 

'  0.92 
0.45 
2.62 

1.10 

1.85 
1.11 
1.28 
1.33 
0.83 
1.22 
2*37 
8.91 
1.69 
1    0 

1 
1 
1 
1 
1 
1 
1 
1 
1 

0.5 

Conner-eel 

0.7 

1 0 

01 

Pike                   

0.1 

Sole 

0.1 

0.7 

0.8 

72.02 
74.14 

0.5 

70.00 

27.00 

0.35 

11.65 

1.  0 

9.15 

9.72 

75.75 

5.38 

1 

13.6 

12.55 

12.11 

0  55 

1.12 

1 

1.7 

12.67 

0.25 

0.59 

1 

0.1 

50.82 

16.24 
3.31 
2.48 

31.75 
3.66 
3  90 

0.13 

4.92 
6.04 

1.09 
0.70 
0.49 

1 
1 
1 

3.4 

87.41 
87.09 

3.4 

5.2 

66.41 

3.70 

25.72 

3.54 

063 

1 

13.1 

27.16 

30.43 

2.53 

4.13 

1 

2.1 

48.02 

32,65 

8.41 

6.80 

4.12 

1 

0.7 

Butter 

14.14 
93.31 

0.86 

0.82 

83.11 
0.24 

0.70 
4.98 

1.19 
0.65 

1 
1 

.  169.9 

Whey 

.      6.6 

87.88 

2.83 

0.94 

7.08 

1.07 

1 

:      3.1 

30.34 

16.07 

12.10 

38.S82 

2.61 

1 

:      37 

1  Containing  16  per  cent,  nitrogen. 


2  Containing  22.26  per  cent,  cane-sugar. 


QUANTITY    AND    CHARACTER    OF    FOOD    NECESSARY. 


85 


Table  IX. 

VEGETABLE    POODS. 


Articles. 


a        ^a 


fca 


I! 


13  it  , 
**  P  S  oo 

SZZa 


Wheat 

Spelt 

Rye 

Barley 

Oats 

Indian  corn  .  .  . 
Hulled  rice.    .    .    . 

Millet 

Buckwheat.    .    .    . 

Beans 

Peas 

Lentils 

Wheat -flour    .    .    . 

Rye-flour 

Barley -flour  .  .  . 
Buckwheat-flour  . 

Oatmeal 

Cornmeal   ... 

Starch 

Macaroni 

Fine  wheat-bread. 
Fresh  rye-bread  . 
English  biscuit.    . 

Potatoes 

Beet  (red)  .  .  .  . 
Sugar-beet  .  .  .  . 
Mangold  root.  .  . 
Carrot  (large)  .  . 
"      (small)  .    . 

Turnip 

Radish 

Horseradish  .  .  . 
Kohl-rabi    .    .    .    . 

Onion 

Leek ....... 

Garlic 

Cucumber  .    .    .    . 

Melon 

Pumpkin 

Tomato 

Asparagus  .  .  .  . 
Green  peas.  .  .  . 
Snap  beans.  .  .  . 
Cauliflower.  .  .  . 
Winter  cabbage.  . 
Savoy  cabbage  .  . 
Red  cabbage  .    .    . 

Spinach 

Lettuce 


13.56 
12.09 
15.2(3 
13.78 
12.92 
13.88 
13.23 
11.26 
11.36 
14.84 
14.31 
12.51 
14.86 
14.42 
15.06 
14.27 
10.46 
14.00 
14.84 
13.07 
38.51 
44  02 
7  45 
75.77 
87.88 
83.91 
90  51 
87.05 
88.32 
91.24 
86.92 
76.72 
85.01 
70  18 
87.62 
64.66 
95.60 
95.21 
90.01 
92.87 
93.32 
80.49 
86.10 
90.39 
80.03 


85.63 
90.26 
94.33 


12.42 

11.02 

11.43 

11.16 

11.73 

10.05 

7.81 

11.29 

10.58 

23.66 

22.63 

24.81 

8.91 

10.97 

11.75 

9  28 

15.50 

11.10 

1.46 

9.02 

6.82 

6.02 

7.18 

1.79 

1.07 

2.08 

1.40 

1.04 

1.04 

0.96 

2.92 

2^73 

2.95 

2.68 

2.83 

6.76 

1.02 

1.06 

0.71 

1.25 

1.98 

5.75 

4.67 

2.53 

3.99 

3.31 

4.83 

3.15 

1.41 


1.70 
2.77 
1.71 
2.12 
6.04 
4  76 
0.69 
3.56 
2.79 
1.63 
1.72 
1.85 
1.11 
1.95 
1.71 
1.89 
6.11 
8.10 


0.28 
0.77 
0.48 
9.28 
0.16 
0.11 
0.11 

0^21 
0.21 
0.16 
0.11 
0.35 
0.22 
0.10 
0  29 
0.06 
0.09 
0.61 
0.05 
0.33 
0.28 
0.50 
0.30 
0.38 
0.90 
0.71 
0.46 
0.54 
0.31 


1.44 

0.96 

2^22 
4.59 

l!l8 


2.32 

3.88 
3.10 
1.06 
2.25 


66.45 
66.44 
66.86 
65.51 
53  21 
62.19 
76.40 
66.15 
55.84 
49.25 
53.25 
54.78 
71.86 
65.86 
67.80 
71.40 
61.42 
65.10 
83.31 


2.37 

2.54 

17.02 

6.55 
9.31 
4.68 
6.74 
1.60 
4.08 
1.53 

0^40 

5.78 
0.44 

0^95 

0.27 
1.36 
2,53 

0.40 


1.27 
1.21 
1.29 

0^08 


76.79 

49.97 

45.33 

58.08 

20.56 

2.43 

2.41 

2.14 

2.66 

7.17 

1.90 

.  6.90 

15.89 

8.45 

19.91 

6.09 

26.31 

1.33 

1.15 

5.87 

1.55 

2.34 

10.86 

6.60 

3  74 

10.42 

4.73 

6.22 

3  26 

2.19 


2.66 
5.47 
2.01 
4.80 

10.83 
2.84 
0.78 
4.25 

16.52 
7.47 
5.45 
3.58 
0.33 
1.62 
0.11 
0.89 
2.24 


0.38 
0.30 
0.16 
0.75 
1.02 
1.14 

1.40 
0.95 
0.91 
1.55 
2.78 
1.76 
0.81 
1.49 
0.77 
0.62 
1.07 
1.36 
0.84 
1.14 
1.60 
1.69 
0.87 
1.88 
1.23 
1.57 
0.77 
0.73 


1.77 
2.21 
L77 
2  63 
3.05 
1.69 
1.09 
2.31 
2.91 
B.15 
2.65 
2.47 
0.61 
1.48 
0.47 
1.21 
2.02 
1.70 
0.39 
0.84 
1.18 
1.31 
0.83 
0.57 
0.94 
1.04 
1.27 
0.90 
0.71 
0.75 
1.07 
1.53 
1.21 
0.54 
1.24 
1.44 
0.39 
0.63 
0.64 
0.63 
0.54 
0.80 
0.64 
0.82 
1.57 
1.64 
1.29 
1.94 
1.03 


5.7 
6.5 
6.2 
6.2 
5.6 
7.5- 
9.9 
6.5 
5.7 
2.2 
2  5 
2.3 
8.5 
6.7 
6.3 
82 
4.8 
6.7 

57.1 
8.6 
7.9 
8.1 

12.7 

11.6 
8.6 
5.7 
5.8 
9.4 
8.8 
6.5 
4.5 
6.0 
3.1 
9.6 
2.5 
3.9 
2.4 
2.4 

10.2 
3.6 
1.6 
2.0 
1.5 
2.2 
3.3 
2.2 
L5 
1.3 
1.9 


86 


TEXT-BOOK    OF   HYGIENE. 


Table  IX  (continued). 

VEGETABLE   FOODS. 


o  S 

-§5 

43 

2 

k$3 

■3*8 

9     . 

+3 

n        of 
ious  to 
itroge- 
tters. 

Articles. 

*=  9 

C  9 
©  ° 

cS  9 

a 

W.  9 

O  m  9 

&53 

>)0 

«  u 

C   9 

9 

o  9  s2 

A 

a 

P. 

p  a 

A  °,9 

O 

£~ 

Mushrooms  (fresh)  .    .    . 

91.11 

2.57 

0.13 

1.05 

3.71 

0.67 

0.76 

1  :    19 

"           (dried)  .   .    . 

17.54 

23  84 

1.21 

9  59 

34.56 

6.21 

7.05 

1:19 

Truffle 

72  80 

8.91 

0  62 

7.54 

7  92 

2.21 

1  :    1.0 

0.39 

7.73 

5  17 

1.98 

0.31 

1  :35.2 

Pears 

83  03 

0.36 

8  26 

3.54 

4  30 

0.31 

1  :33.3 

84.86 

0  40 

3  56 

4  68 

4.34 

0.66 

1  :24  3 

0.65 

4  48 

7.17 

6.06 

0  69 

1  :19.3 

81.22 

0  49 

4  69 

6.35 

5.27 

0.82 

1  :24  9 

80.26 

0  62 

10.24 

117 

6.07 

0.73 

1  :19.9 

Grapes 

78.17 

0.59 

14  36 

1.96 

3.60 

0.53 

1  :29  0 

Strawberries 

87.66 

1.07 

0.45 

6.28 

0.48 

2.32 

0  81 

1:78 

86.21 

0.53 

3.95 

154 

590 

0  49 

1  :13.0 

86.41 

0.51 

4.44 

1.76 

5  21 

0  48 

1  :14.5 

84.71 

0  36 

9  19 

2  31 

0.91 

0.66 

1  :37.1 

78.36 

0.78 

5.02 

0.87 

12  29 

102 

1  :    9.7 

0.47 

7.03 

1.40 

3  52 

0.42 

1  :21.0 

84  77 

0.51 

6  38 

0  90 

4  57 

0.72 

1-:18.5 

1.06 

41  61 

14.68 

5.59 

1.96 

1  :55.6 

"      pears   

29  41 

2  07 

0.35 

29  13 

29.67 

6  86 

1.67 

1  :29.1 

29  83 

2  55 

0.53 

42  65 

18.85 

1.43 

1.39 

1  :25.5 

49.88 

2.07 

0  30 

31.22 

14.29 

0.612 

1.63 

1  :22  2 

32.02 

2.42 

0.59 

54  56 

7.48 

1.72 

1.21 

1  :26  0 

"      fi>s 

32,21 

5.06 

45.28 

2.96 

1  :    8.9 

Sweet  almonds ...... 

5.39 

24.18 

53  68 

7.23 

6.56 

2.96 

1  :    4.2 

Walnut       

4.68 
3  77 

16.37 
15.62 

62.86 
66.47 

7.89 
9.03 

6.17 
3.28 

2.03 
1.83 

1  :    7.2 

Hazel -nnt 

1  :    8.0 

Chestnuts  (fresh)    .    .    . 

51.48 

5  48 

1.37 

38.34 

1.61 

1.72 

1  :    7.5 

6.50 

28.20 

46.40 

15.70 

3.20 

1  :    2.3 

Iii  addition  to  maintaining  a  proper  proportion  between  the 
various  alimentary  principles,  it  is  necessary  to  vary  the  articles 
of  food  themselves,  otherwise  they  are  liable  to  prove  nauseating. 
The  necessity  of  variety  in  the  food,  in  order  to  preserve  the 
appetite,  is  familiar  to  every  one. 

By  keeping  the  proportions  of  the  above  table  in  view  it 
will  be  seen  at  once  that  if  a  man  wished  to  live  on  beef  alone 
he  would  be  obliged  to  eat  about  2  kilogrammes  per  day  in 
order  to  get  a  sufficient  amount  of  non-nitrogenous  food.     Of 


1  These  green  fruits  all  contain  in  addition  from  .2  to  2.1  per  cent,  of  free  acid. 
3  Without  stones. 


QUANTITY    AND    CHARACTER   OF   FOOD    NECESSARY.  87 

potatoes,  in  order  to  get  enough  nitrogenous  food,  he  would  have 
to  eat  daily  8  kilogrammes.  No  human  stomach  could  prove 
equal  to  the  task  of  digesting  this  excess  of  material.  On  the 
other  hand,  it  is  to  be  noted  how  perfect  the  combination  of  the 
various  principles  is  in  human  milk.  In  cows'  milk,  which  is 
nearest  in  composition  to  human  milk,  the  non-nitrogenous 
principles  are  deficient.  Hence,  the  important  practical  point 
that  when  ordering  milk  diet  for  a  patient  a  small  portion  of 
carbonaceous  food  (bread,  rice,  or  sugar)  must  be  added  if  the 
standard  of  health  shall  be  reached  or  maintained. 

Climate  has  probably  very  little  influence  upon  the  amount 
of  food  required  by  the  individual.  The  actual  quantity  of  food 
consumed  varies  little  between  various  races  or  in  different  parts 
of  the  earth.  It  is  true,  however,  that  a  larger  proportion  of  fat 
is  required  in  cold  climates.  That  fatty  articles  of  food  readily 
undergo  oxidation  and  furnish  a  large  amount  of  animal  heat  is 
proven  both  by  observation  and  experiment. 

The  albuminoid  proximate  principles  of  the  food,  proteids, 
are  represented  by  the  nitrogenous  constituents  of  organic 
tissues.  These  are  the  vitellin  and  albumin  of  eggs,  albumin, 
fibrin,  globulin,  myosin,  syntonin,  and  other  nitrogenized  prin- 
ciples of  flesh  and  blood  ;  the  casein  of  milk,  the  gluten,  fibrin, 
and  legumin  of  cereal  and  leguminous  seeds  and  plants,  gelatin, 
and  chondrin. 

.  Fat  constitutes  an  integral  component  of  animal  tissue,  and 
is  found  in  abundance  as  a  constituent  of  nerve-tissue,  marrow, 
and  subcutaneous  connective  tissue.  In  food  it  is  represented 
especially  in  the  fatty  tissue  of  meat,  the  yelk  of  eggs,  butter, 
etc. 

The  carbohydrates  are  represented  especially  by  various 
products  of  the  vegetable  world,  as  sugar,  starch,  dextrin,  etc. 

Water  and  the  various  other  inorganic  proximate  princi- 
ples, chief  among  which«are  compounds  of  calcium,  sodium,  and 
potassium,  are  usually  found  in  sufficient  proportion  in  the  other 
alimentary  substances. 


88  TEXT-BOOK    OF    HYGIENE. 

The  food  should  be  taken  in  appropriate  quantities  and 
properly  prepared.  A  larger  quantity  than  necessary  may  over- 
tax the  digestive  organs  and  thus  yield  less  than  the  required 
amount  of  nutritive  material  to  the  body. 

Physical  exertion  increases  the  consumption  of  fatty  prin- 
ciples. Hence,  as  in  the  cases  of  the  athlete  or  prize-fighter  in 
training,  larger  quantities  of  these  principles  are  required  to  keep 
the  nutrition  of  the  body  at  the  standard  of  health.  During 
mental  work,  however,  less  carbohydrate  material  is  consumed 
than  during  physical  labor. 

The  greater  consumption  of  carbohydrates  during  muscular 
exercise  is  shown  by  the  following  table,  which  gives  the  amounts 
of  carbon  dioxide  and  nitrogen  excreted  by  a  man  at  rest  and 

during  labor : — 

Table  X. 


At  rest 
At  work 


CO.  Excreted. 


2.1  per  cent. 

2.6    "      " 


Nitrogen  Excreted. 


1.1  per  cent. 
1.1    "      " 


In  youth  the  processes  of  combustion  (production  of  carbon 
dioxide)  go  on  with  greater  rapidity  than  after  adult  life  is 
reached.  For  this  reason  young  persons  rarely  get  fat,  the  fat- 
producing  food  being  burnt  up  in  the  body  by  the  greater  meta- 
bolic activity  of  the  young  cell.  Hence,  fats  and  carbohydrates 
should  form  a  larger  relative  proportion  in  the  diet  of  the  young 
than  in  that  of  grown  persons. 

Low  external  temperature  causes  a  greater  and  more  rapid 
consumption  of  fat  than  high  external  temperature.  During 
febrile  conditions,  however,  the  destruction  of  stored-up  fat  in  the 
body — the  wasting  away — is  one  of  the  most  notable  phenomena; 
hence  the  importance  of  supplying  fat  and  fat-producing  food 
in  chronic  febrile  diseases. 

"  Der  Mensch  ist  was  er  isst"  said  Ludwig  Feuerbach.1 

i  Gottheit,  Freikeit  und  Unsterblichkeit  von  Standpunkt  der  Anthropologic,  p.  5. 


CLASSIFICATION    OF   FOODS.  89 

The  pungency  of  the  epigram  is  somewhat  lost  in  the  transla- 
tion, which  is,  literally,  "Man  is  what  he  eats."  The  intimate 
relations  of  mental,  moral,  and  physical  conditions  of  health  to 
the  quality  and  quantity  of  food  deserve  the  earnest  attention 
of  the  educated  physician  and  sanitarian. 

CLASSIFICATION    OF   FOODS. 

Foods  and  victuals  are  generally  divided  into  foods  proper 
and  so-called  accessory  aliment.  The  classification  is  not  exact, 
however,  as  the  latter,  which  are  commonly  regarded  as  articles 
of  luxury,  may  under  certain  circumstances  become  necessities, 
and  hence  should  not  be  considered  as  forming  a  separate  class. 

Foods  are  either  of  animal  or  vegetable  origin.  Those  de- 
rived from  animal  sources  are  milk,  the  flesh  of  animals,  birds, 
reptiles,  and  fish,  and  the  eggs  of  the  three  last  named. 

The  foods  derived  from  the  vegetable  kingdom  comprise 
the  seeds  of  various  plants  (cereals,  legumes),  roots,  herbs,  ripe 
fruits,  the  fleshy  envelopes  of  various  seeds  (which  may  prop- 
erly be  classed  with  the  fruits),  and  various  fungi. 

There  are  also  in  common  use  a  number  of  beverages,  e.g., 
water,  alcoholic  liquors,  alkaloidal  infusions  (tea,  coffee,  cocoa), 
etc. 

In  addition,  a  number  of  substances  or  compounds  are  in 
common  use  as  condiments.  Their  function  is  either  to  render 
victuals  more  palatable,  or  to  promote  digestion  and  assimilation. 
Vinegar,  mustard,  and  common  salt  are  familiar  examples. 

FOODS   OF    ANIMAL    ORIGIN. 

Milk. — Human  milk  is,  so  far  as  known,  the  one  perfect 
food  for  man  found  in  nature.  It  contains,  in  proper  proportion, 
representatives  of  all  the  different  classes  of  proximate  principles 
necessary  to  nutrition.  One  hundred  parts  contain  about  2.5 
parts  of  proteids  (casein  and  albumin)  ;  3.9  parts  of  fat  (butter) ; 
6.0  parts  of  sugar,  and  .5  of  salts.  The  reaction  of  human 
milk  is  slightly  alkaline ;  that  of  fresh  cows'  milk  is  neutral. 


90  TEXT-BOOK   OF   HYGIENE. 

In  human  milk  there  are  12.9  parts  of  solid  matter  to  87.1 
of  water,  while  in  cows'  milk  the  proportions  are :  Proteids,  4.0 
per  cent.;  fats,  3.4  per  cent.;  sugar,  3.8  per  cent.;  salts,  0.6  per 
cent.,  or  11.8  total  solids  and  88.2  water.1 

Of  the  solids  in  milk,  cows'  milk  contains  more  proteids, 
while  human  milk  is  richer  in  fats  and  sugar.  Hence,  in  using 
cows'  milk  as  a  substitute  for  human  milk  the  proteids  are  di- 
luted by  the  addition  of  water,  and  the  non-nitrogenous  com- 
ponents increased  by  adding  sugar  and,  under  some  circum- 
stances, fat  (cream). 

Goats'  and  asses'  milk  are  sometimes  used  as  substitutes 
for  human  milk,  but  they  do  not  approach  much  nearer  in  com- 
position to  the  latter  than  does  cows'  milk. 

On  standing,  the  fatty  constituent  of  milk,  the  cream,  sepa- 
rates, and  on  account  of  its  less  specific  gravity  rises  to  the 
surface,  where  it  forms  a  layer  of  varying  thickness. 

After  standing  a  longer  interval  the  milk  undergoes  certain 
physical  and  chemical  changes.  Lactic  acid  is  formed  at  the 
expense  of  part  of  the  sugar  of  milk  (a  sort  of  fermentation 
taking  place),  and,  acting  upon  the  casein,  produces  coagulation. 
This  is  the  so-called  "  bonny-clabber."  When  the  fermentation 
continues,  especially  under  a  slightly  elevated  temperature,  the 
solid  portion  becomes  condensed  (curd),  and  a  sweetish-acid, 
amber-colored  liquid,  the  whey,  separates.  The  curd,  after 
further  fermentation,  under  appropriate  treatment,  becomes 
converted  into  cheese. 

Whey  is  sometimes  used  alone  or  mixed  with  wine  as  an 
article  of  diet  for  the  sick.    . 

Butter  is  made  from  the  cream  by  prolonged  agitation  in  a 
churn.  The  fat-globules  adhere  to  each  other  and  form  a  soft, 
unctuous  mass,  of  a  yellowish  color,  solid  at  ordinary  tem- 
peratures. After  the  butter  is  all  removed  in  this  way  the 
balance  of  the  cream  remains  in  the  churn  as  buttermilk.  This 
is  an  article  of  considerable  nutritive  value,  although  its  excess 

1  Average  of  a  number  of  analyses. 


FOODS    OF    ANIMAL    ORIGIN.  91 

of  acid  renders  it  unsuitable  as  an  article  of  diet  in  many 
cases. 

The  specific  gravity  of  fresh  milk  should  not  be  below 
1030.  It  should,  however,  be  borne  in  mind  that  the  richest 
milk  is  not  always  that  which  has  the  highest  specific  gravity. 
In  fact,  a  sample  of  rich  milk,  containing  a  large  proportion  of 
cream,  may  show,  when  tested  with  the  lactometer,  a  lower 
specific  gravity  than  a  specimen  of  much  poorer  milk.  Hence, 
the  lactometer,  although  a  useful  instrument  in  guarding  against 
excessive  dilution  of  the  milk  with  water,  is  not  a  very  trust- 
worthy guide  in  determining  the  quality  of  the  milk. 

Objections  are  often  urged  against  the  use  of  so-called 
"  skim-milk,"  i.e.,  milk  from  which  the  cream  has  been  removed. 
In  some  cities  in  this  country  the  police,  or  representatives  of 
the  sanitary  authorities,  seize  and  confiscate  all  skim-milk  found 
in  possession  of  dealers.  There  appears  to  be  no  rational  basis 
for  the  opinion  held  by  many  that  skim-milk  is  not  a  proper 
and  useful  article  of  food.  Before  the  lactic-acid  fermentation 
has  taken  place  it  differs  from  fresh  milk  merely  in  the  fatty 
and  other  matters  removed  in  the  cream.  It  contains  nearly  all 
of  the  proteids,  sugar,  and  salts  of  whole  milk,  and  may  be  used 
as  an  article  of  food  with  great  advantage  and  entire  safety.  In 
certain  diseased  states  it  is  of  exceptional  value  as  an  article  of 
diet.  The  sole  objection  of  any  weight  to  skim-milk  is  that  it 
may  be  at  times  sold  fraudulently  as  fresh  milk.  This  is,  how- 
ever, a  question  of  little  sanitary  interest,  but  one  principally  of 
commercial  ethics. 

Milk  is  frequently  adulterated  by  the  addition  of  water. 
More  deleterious  substances  are  rarely  found.  An  excess  of 
water  gives  the  milk  a  bluish  tinge  and  reduces  its  specific 
gravity.  The  addition  of  water  may  become  especially  dangerous 
by  introducing  the  virus  of  some  of  the  acute  infectious  diseases. 
Thus,  the  localized  epidemics  of  typhoid  and  scarlet  fevers  have, 
in  quite  a  number  of  instances,  been  traced  to  mixing  the  milk 
with  water  containing  the  poison  of  these  diseases.     It  should, 


92  TEXT-BOOK    OF    HYGIENE. 

however,  be  stated  that  milk  which  contains  the  virus  of  typhoid 
fever  has  not  necessarily  been  adulterated  by  the  addition  of 
water.  The  poison  may  have  been  introduced  with  the  water 
used  in  washing  the  can,  and  adhered  to  the  sides  of  the  latter. 
In  filling  the  can  with  milk  a  good  culture  medium  is  supplied 
in  which  the  typhoid  bacillus  flourishes. 

It  has  long  been  a  mooted  question  whether  acute  or  chronic 
infectious  diseases  of  the  milk-giving  animal  may  be  communi- 
cated to  persons  using  the  milk  of  such  animals.  While  there 
is  little  positive  knowledge  upon  the  subject,  it  would  seem 
prudent  to  avoid  the  use  of  milk  from  diseased  animals,  if  pos- 
sible, or  to  destroy  any  organic  virus  the  milk  may  contain  by 
previously  boiling  the  milk.  After  thorough  boiling  little  fear 
need  be  entertained  of  communicating  either  acute  or  chronic 
infectious  diseases  through  this  medium.  Demme  and  Uffel- 
mann  have  reported  cases  which  seem  to  demonstrate  the  pos- 
sibility of  tuberculous  infection  through  the  medium  of  the  milk. 
Professor  Bang,  of  Copenhagen,  has  recently  made  a  series  of 
experiments  and  observations  which  has  led  him  to  the  con- 
clusion that  the  milk  of  tuberculous  cows  and  tuberculous 
women,  in  which  there  are  no  lesions  in  the  mammary  gland, 
only  exceptionally  contains  the  contagium.  Professor  Bang  at 
the  same  time,  however,  points  out  that  the  milk  from  tubercu- 
lous udders  is  extremely  dangerous,  and  that  the  tubercle  bacilli 
are  to  be  found  not  only  in  the  milk  itself,  but  in  the  cream, 
buttermilk,  and  butter  made  from  it;  and  that  such  milk  is 
sometimes  infective  by  ingestion,  even  after  exposure  to  65°  C. 
of  heat,  and  by  injection  into  the  peritoneal  cavity  after  exposure 
to  80°  C. 

The  infectiousness  of  the  milk  of  cows  suffering  from 
splenic  fever  (milzbrand,  anthrax)  has  been  proven  by  Bollinger 
and  Feser.  Anthrax  bacilli  have  been  found  in  such  milk  by 
Chambrelent  and  Moussons. 

The  agency  of  milk  in  the  spread  of  scarlet  fever  is  well 
recognized,   but  the  manner  in  which  the  contagium  gained 


FOODS    OF    ANIMAL    ORIGIN".  93 

access  to  the  milk  was  not  well  understood.  Recently,  however, 
an  incident  happened  in  England  which  seems  to  prove  a  close 
connection  between  this  widespread  and  fatal  disease  and  a  dis- 
order in  the  milk  cattle.  The  evidence  in  support  of  this  view  is 
as  follows :  Mr.  W.  H.  Power,  of  the  English  Local  Government 
Board,  was  detailed  to  investigate  certain  outbreaks  of  scarlet 
fever  which  seemed  to  have  especial  relation  to  the  milk-supply 
from  a  particular  dairy-farm.  Upon  inspection  this  dairy  was 
found  to  be  in  excellent  sanitary  condition  as  regards  cleanliness, 
water-supply,  sewerage,  etc.,  and  for  a  time  considerable  difficulty 
was  experienced  in  locating  the  cause  of  the  outbreaks.  Im- 
probable as  it  may  at  first  sight  appear,  it  seems  to  have  been 
incontestably  established  that  the  epidemics  of  scarlatina  were 
due  to  the  use  of  milk  obtained  from  cows  attacked  by  a  peculiar 
disease  manifested  by  a  vesicular  eruption  followed  by  ulceration 
of  the  udder.  The  chain  of  circumstances  connecting  the  dis- 
ease in  the  cows  with  the  outbreaks  of  scarlet  fever  in  certain 
districts  in  London,  supplied  with  milk  from  the  diseased  coavs, 
was  so  strongly  forged  by  the  able  investigator,  into  whose  hands 
the  work  had  been  committed  by  the  authorities,  that  hardly  a 
doubt  can  exist  that  the  one  disease  owed  its  origin  to  the  other. 

The  pathological  evidence  furnished  by  Dr.  Klein  lends 
strong  support  to  the  view  that  the  Hendon  cow  disease  and 
scarlet  fever  are  intimately  related  to  each  other.  A  bacterial 
organism  was  found  in  the  material  from  the  ulcerated  udders 
of  the  sick  cows,  which  presents  similar  characters  to  a  micro- 
coccus found  by  the  same  observer  in  the  blood  of  scarlet-fever 
patients.  These  results  require  more  extended  investigations 
before  they  can  be  unreservedly  accepted. 

The  milk  of  cows  fed  upon  the  refuse  of  breweries  and  dis- 
tilleries— "swill-milk" — is  believed  by  many  physicians  to  be 
unwholesome.  If  so,  it  is,  probably,  only  by  reason  of  the  un- 
favorable hygienic  conditions  under  which  the  animals  are  kept. 
If  the  stables  are  clean,  dry,  and  well  ventilated,  and  the  ani- 
mals receive  plenty  of  fresh  air  and   exercise,  swill-fed  cows 


94  TEXT-BOOK   OF   HYGIENE. 

should  produce  as  nutritious  milk  as  when  they  are  fed  upon 
different  food.  Much  of  the  present  agitation  against  "swill- 
milk"  is  more  prompted  by  political  demagogism  than  by 
scientific  knowledge. 

The  milk  of  animals  suffering  from  certain  diseases  is  often 
dangerous  to  health.  In  some  of  the  Western  and  Southern 
United  States,  cows  are  not  infrequently  attacked  by  an  acute 
febrile  disease  called  "  the  trembles,"  from  one  of  the  prominent 
symptoms.  The  milk  of  cows  suffering  from  this  disease  pro- 
duces severe  gastrointestinal  disorder,  collapse,  fever,  etc.,  in 
the  consumer.  This  disease,  called  "  milk-sickness,"  is  fatal  in 
a  pretty  large  proportion  of  cases.  It  is  said  that  the  flesh  of 
animals  with  "the  trembles"  will,  if  eaten,  produce  similar  dan- 
gerous effects.  A  late  writer  (Dr.  Beach,  of  Ohio)  estimates 
that  25  per  cent,  of  the  Western  pioneers  and  their  families 
died  of  this  disease. 

For  the  ready  determination  of  the  quality  of  milk,  instru- 
ments known  as  lactoscopes,  lactometers,  and  creamometers  are 
used.  The  lactoscope  indicates  the  opacity  of  the  milk,  upon 
which  the  proportion  of  cream  depends.  One  convenient  mod- 
ification of  the  lactoscope  is  the  little  instrument  termed  the 
pioscope.  This  consists  of  a  disk  about  6§  centimetres  in  diam- 
eter, with  a  slight  depression  in  the  centre.  A  little  milk  is 
placed  in  the  depression  and  covered  with  a  glass  disk,  clear 
in  the  centre  and  opaque  around  the  border,  which  is  divided 
into  six  divisions  of  different  shades,  varying  from  white  to 
dark  gray.  The  quality  of  the  milk  is  marked  upon  the 
division  whose  color  corresponds  with  that  of  the  milk  in 
the  centre. 

A  better,  but  still  not  very  accurate,  indicator  of  the  quality 
of  the  milk  is  the  creamometer.  This  consists  of  a  cylindrical 
glass  vessel  with  the  upper  half  divided  up  into  hundredths. 
The  glass  is  filled  up  to  the  zero  mark  with  milk,  and  allowed 
to  stand  until  all  the  cream  has  separated.  The  thickness  of 
this  layer  is  then  read  off  on  the  scale.     In  Chevallier's  instru- 


FOODS    OF    ANIMAL    ORIGIN. 


95 


ment,  10  per  cent,  of  cream   is  the  minimum  proportion  that 
should  be  furnished  by  the  milk. 

The  specific  gravity,  which  is  a  fair  guide  to  the  quality  of 
the  milk,  with  the  reservations  above  mentioned,  is  measured  by 
means  of  the  lactometer  or  lactodensimeter.  The  specific 
gravity  of  good  cows'  milk  should  not  be  less  than  1029. 

In  order  to  prevent  the  rapid  fermentation  of  milk  various 
methods  of  preservation  have  been  adopted.  The  addition  of 
alkalies,  or  antiseptics,  retards  the  lactic-acid  fermentation,  while 
the  abstraction  of  a  portion  of 
the  water  and  addition  of  sugar 
(condensed  milk)  preserves  it 
for  an  indefinite  time.  The 
mere  addition  of  water  restores 
it  to  nearly  its  original  condition. 

Tyrotoxicon  in  Milk.-r—This 
substance,  first  found  in  poison- 
ous cheese,  and  later  in  milk,  ice- 
cream, custards,  etc.,  is  believed 
by  Professor  Vaughan  to  be  the 
cause  of  true  cholera  infantum, 
and  many  of  the  clinical  phe- 
nomena of  this  disease  lend 
strong  support  to  such  a  view. 
The  conditions  under  which  the 
poison  is  developed  have  not  yet 
been  sufficiently  studied  to  enable  correct  conclusions  to  be  drawn. 

Butter. — Butter  is  of  especial  value  as  food  on  account  of 
the  large  amount  of  easily  digestible  fat  which  it  contains.  It  is 
almost  always  used  as  accessory  to  other  articles  of  food,  to  ren- 
der them  more  palatable.  When  pure  and  fresh,  it  is  one  of  the 
most  delicious  of  creature  comforts.  It  soon  undergoes  the 
butyric-acid  fermentation,  however,  becoming  "rancid,"  as  it  is 
termed,  when  it  is  unfit  for  food. 

The  great  demand  for  butter  and  its  consequent  high  price 


Fig.  3.-Ceevallier's  Creamometer. 


96  TEXT-BOOK   OF   HYGIENE. 

have  led  to  its  extensive  sophistication.  Butter  is  now  very 
largely  substituted  by  an  artificial  product  termed  oleo-margarine, 
or  butterine.  This  artificial  butter  is  made  from  beef-suet  by  the 
following  process :  Fresh  beef-fat  is  melted  at  as  low  a  temperature 
as  possible,  never  higher  than  52°  to  53°  C.  [126°  to  128°  F.]. 
All  membrane  and  tissue  are  then  removed,  and  the  resulting 
clear  fat  is  put  into  presses,  where  the  stearine  is  extracted. 
The  liquid  fat,  free  from  tissue,  and  with  nearly  all  its  stearine 
removed,  is  known  as  "oleo-margarine  oil."  The  next  step 
in  the  process  is  "  churning."  The  oil  is  allowed  to  run  into 
churns  containing  milk  and  a  small  quantity  of  coloring 
material  (annatto),  where,  by  means  of  rapidly-revolving  pad- 
dles, it  is  churned  for  about  an  hour.  When  this  part  of  the 
process  is  complete,  the  substance  is  drawn  off  from  the 
bottom  of  the  churn  into  cracked  ice.  When  cool  it  is  taken 
from  the  ice,  mixed  with  a  proper  quantity  of  salt,  and  is  then 
worked  like  butter  and  put  into  firkins  for  the  market.  It  is 
also  molded  into  attractive  prints  in  imitation  of  dairy-butter.1 
When  the  materials  from  which  oleo-margarine  is  made  are 
sweet  and  clean,  and  when  the  process  of  manufacture  is  prop- 
erly conducted,  the  resulting  product  is  an  entirely  harmless 
article,  and  probably  differs  very  little  in  nutritive  value  from 
butter  itself. 

Cheese. — The  value  of  cheese  as  a  food  depends  upon  the 
large  amount  of  proteids  and  fat  which  it  contains.  The  rich 
varieties  of  cheese,  such  as  Fromage  de  Brie  and  Roquefort,  con- 
tain on  an  average  30  per  cent,  of  fat  and  27  per  cent,  of  proteid 
compounds.  Parmesan  contains  only  about  8  per  cent,  of  fat 
and  nearly  33  per  cent,  of  proteids,  while  Edam  and  Chester 
cheese,  which  may  be  considered  as  standing  about  midway 
between  the  above,  contain  20  per  cent,  of  fat  and  nearly  28 
per  cent,  of  proteids.  From  these  figures  it  appears  that  cheese 
is  one  of  the  most  nutritious  aliments  obtainable,  but  it  cannot 

1  Dr.  W.  K.  Newton,  Fifth  Annual  Report  of  the  State  Board  of  Health  of  New  Jersey, 
1881,  p.  107. 


FOODS    OF    ANIMAL    ORIGIN. 


97 


be  eaten  in  large  quantities  at  a  time,  as  it  is  exceedingly  liable 
to  cause  disturbances  of  the  digestive  organs.  The  constipating 
property  of  cheese  is  well  known  to  the  public. 

The  relative  value  of  different  kinds  of  cheese  in  alimentary- 
principles  is  given  in  the  following  table: — 


Table 

XL 

Kind  of  Cheese. 

Proteids 
(percent.). 

Fats 
(per  cent.). 

Sugar 

(per  cent.). 

Salts 
(per  cent.). 

27.68 

27.46 

5.89 

5.01 

24.07 

30.26 

4.48 

4.91 

29.48 

26.71 

2.27 

4.62 

27.69 

33.44 

3.15 

5.35 

17.44 

40.80 

5.21 

2.05 

Parmesan 

41.19 

19.52 

1.18 

6.31 

Cheese  is  not  often  adulterated.  The  only  articles  used 
with  success  in  its  sophistication  are  lard  and  oleo-margarine, 
which  are  incorporated  with  the  casein  during  the  process  of 
manufacture.  It  sometimes  undergoes  chemical  changes  which 
render  it  intensely  poisonous  when  eaten. 

Prof.  V.  C.  Vaughan,  of  the  University  of  Michigan,  has 
ascertained  that  the  substance  causing  the  poisonous  symptoms 
is  a  chemical  compound  termed  by  him  tyrotoxicon.  This 
same  poison  has  also  been  found  by  Professor  Vaughan  and 
other  chemists  in  ice-cream  and  fresh  milk,  which  produced 
poisonous  symptoms  when  consumed.  The  poison  is  supposed 
to  be  a  ptomaine  produced  by  the  agency  of  a  micro-organism, 
which  has,  however,  not  yet  been  isolated. 

Meat. — The  flesh  of  mammals,  reptiles,  birds,  fish,  and 
invertebrate  animals  is  used  as  food  by  man.  Falck l  has  classi- 
fied the  varieties  of  animals  which  furnish  food  to  the  inhabitants 
of  Europe.  There  are  47  varieties  of  the  mammalian  class, 
105  of  birds,  7  of  amphibia,  110  of  fish,  and  58  of  invertebrates. 

1  Das  Fleisch,  Gemeinverstsendlicnes  Handbuch  der  Wissenschaf  tlichen  und  Praktischen 
Fleiscbkunde. 

7 


98 


TEXT-BOOK    OF    HYGIENE. 


Meat  is  the  most  important  source  of  proteids  in  the  food. 
In  the  more  commonly  used  varieties  of  meat  the  proteids  and 
fats  constitute  from  25  to  50  per  cent,  of  the  entire  bulk,  the 
proportion  depending  largely  upon  the  age  of  the  animal  and  its 
bodily  condition.  The  following  table  shows  the  influence  of 
these  two  factors  upon  the  relative  proportions  of  the  fats  and 
proteids  contained  in  the  meat: — 

Table  XII.1 


Mocleratety  fat  beef 
Lean  beef  .     .     .     . 

Teal 

Very  fat  mutton 
Fat  pork     .     .     .     . 
Lean  pork  .     .     .     . 

Hare 

Lean  chicken  .     .     . 


Proteids  (per  cent. 


21.39 
20.54 
10.88 
14.80 
14.54 
19.91 
23.34 
19.72 


Fats  (per  cent.). 


5.19 
1.78 
7.41 
36.39 
37.34 
6.81 
1.13 
1.42 


The  flesh  of  animals,  which  is  neutral  in  reaction  immedi- 
ately after  death,  soon  becomes  acid  in  consequence  of  the 
formation  of  lactic  acid.  The  acid,  acting  upon  the  sarcolemma 
and  the  muscular  fibre,  renders  it  softer  and  more  easily  per- 
meable by  fluids  when  cooking,  and  more  susceptible  to  the 
action  of  the  gastric  juice  when  the  meat  is  taken  into  the 
stomach. 

Certain  kinds  of  meat — mutton  and  venison,  for  example — 
are  often  kept  so  long  before  being  eaten  that  a  considerable 
degree  of  putrefaction  has  taken  place  when  they  are  brought 
upon  the  table.  The  wisdom  of  this  practice  is  questionable 
from  a  hygienic  point  of  view. 

Meat  is  sometimes  eaten  raw,  but  it  is  usually  first  cooked. 
The  methods  of  cooking  in  general  use  are  boiling,  frying, 
roasting,  broiling,  and  baking.     By  either  of  these  methods  of 


'Abridged  from  Loebisch ;  article  "Fleisch"  in  Realencyclopsedie  d.  ges.  Heilkunde, 
vol.  v,  p.  340.    Fuller  details  will  be  found  in  Table  VIII. 


FOODS    OF    ANIMAL    ORIGIN.  99 

cooking,  when  properly  carried  out,  the  nutritious  properties  of 
the  meat  are  preserved,  and  it  is  rendered  digestible.  The 
culinary  art  deserves  the  closest  attention  of  students  of  hygiene. 

A  number  of  soluble  preparations  of  meat  (beef-extract, 
beef-essence,  beef-juice)  are  found  in  the  market,  and  highly 
recommended  as  containing  all  the  nutritious  qualities  of  the 
meat  from  which  they  are  prepared.  These,  and  similar  products 
of  domestic  preparation  (broths  and  teas),  contain  in  reality 
very  little  nutritive  material,  but  are  of  use  almost  solely  as 
stimulants  to  the  appetite  and  digestion.  They  have  a  place  in 
the  dietary  of  the  sick,  but  their  nutritive  value  is  small. 

On  the  other  hand,  a  number  of  partly  or  wholly  predi- 
gested  (peptonized  or  pancreatized)  preparations  of  meat  are 
offered  for  sale,  many  of  which  have  a  high  nutritive  value. 
They  cannot,  however,  be  used  as  articles  of  diet  except  for  a 
short  time,  or  as  a  temporary  succedaneum  for  meat  in  diseases 
attended  with  weakness  or  derangement  of  the  digestive  organs. 

Meat  may  be  unfit  for  food  from  various  causes.  Thus 
the  flesh  of  animals  dying  from  certain  diseases — splenic  fever, 
pleuro- pneumonia,  tuberculosis  in  its  advanced  stages,  cow-  or 
sheep-  pox — should  not  be  used  as  food  when  it  can  be  avoided. 
Cases  are  on  record  proving  the  poisonous  character  of  meat 
from  animals  which  suffered,  at  the  time  of  death,  from  some  of 
the  above-mentioned  diseases.  The  most  important  condition 
to  be  borne  in  mind  is  that  certain  parasites  (trichina  spiralis, 
echinococcus,  cysticercus),  which  frequently  infest  the  flesh  of 
animals,  especially  hogs,  not  infrequently  give  rise  to  serious  or 
even  fatal  diseases  in  persons  consuming  such  meat.  Any  meat 
containing  these  parasites,  or  suspected  of  containing  them, 
should  therefore  not  be  used  as  food  unless  precautions  be  first 
taken  to  destroy  the  life  of  the  parasite. 

Of  the  parasites  mentioned  the  trichina  spiralis  is  the  most 
important  in  this  connection,  as  it  frequently  occurs  in  the  flesh 
of  hogs,  rats,  dogs,  cats,  and  other  carnivorous  animals.  Eats 
are  said  to  be  infested  with  the  parasite  more  frequently  than 


100  TEXT-BOOK   OF    HYGIENE. 

any  other  animals.  The  trichinae  are  found  in  two  forms,  one, 
the  mature  form,  inhabiting  the  intestinal  canal.  The  immature 
form,  or  muscle  trichinae,  are  found  in  striped  muscle,  coiled  into 
spirals  and  encysted  in  a  fibrous  capsule.  They  gain  access  to 
their  host  in  the  following  manner:  Flesh  containing  living 
trichinae  is  taken  into  the  stomach,  where  the  muscular  tissue 
and  the  fibrous  envelope  are  dissolved,  and  the  inclosed  worms 
set  free.  These  mature  in  the  intestinal  canal,  where  sexual 
reproduction  takes  place,  and  the  young  embryos  pass  through 
the  intestinal  walls  and  other  tissues  until  they  become  imbedded 
in  striated  muscle.  Localized  epidemics  of  trichinosis  have 
been  reported  in  this  country  and  Europe,  and  in  nearly  every 
instance  the  source  of  the  disease  has  been  traced  to  the  inges- 
tion of  uncooked  pork.  Meat  known  to  be  trichinous  should 
not  be  used  unless  in  times  of  great  scarcity.  It  may,  however, 
be  rendered  innocuous  by  thorough  cooking.  A  temperature 
of  60°  to  70°  (140°  to  160°  F.)  destroys  the  life  of  the  parasite 
and  renders  the  meat  safe.  On  account  of  the  frequent  occur- 
rence of  trichinae  in  pork,  this  meat  should  never  be  eaten  unless 
thoroughly  cooked.  It  has  been  ascertained  that  salted  and 
smoked  pork  is  not  free  from  danger,  as  the  parasites  are  not 
killed  in  the  process  of  curing  the  meat.  Hence,  ham  and 
sausage  should  not  be  eaten  raw,  as  the  danger  from  these 
articles  is  almost  equally  as  great  as  from  fresh  pork. 

Cysticercus  cellulosa,  the  transition  form  of  one  variety  of 
tape-worm,  and  which  is  the  parasite  in  measly  pork,  may  also 
gain  entrance  to  the  human  body,  and,  failing  to  undergo  devel- 
opment, cause  very  serious  lesions  of  various  organs  and  tissues. 
The  frequency  of  tape-worm  is  evidence  that  pork  is  often  thus 
diseased. 

The  use  of  partially  decayed  meat  or  fish  has  often  been 
the  cause  of  serious  or  fatal  illness.  Sometimes  the  illness  par- 
takes of  the  character  of  septic  infection.  In  these  cases  it  is 
probable  that  the  morbid  process  is  due  to  the  action  of  the 
organisms  of  putrefaction.     In  other  cases  the  symptoms  are 


FOODS    OF    ANIMAL    ORIGIN.  101 

widely  different.  These  cases  have  been  the  source  of  much 
perplexity  to  physicians  and  toxicologists  until  very  recently. 
Within  the  past  six  years,  however,  Selmi,  Husemann,  Brouardel, 
Casali,  and  others  have  drawn  attention  to  certain  intensely 
poisonous  chemical  compounds  found  in  decomposing  flesh,  and 
which  have  been  named  by  Selmi  ptomaines.  While  there  is 
still  much  uncertainty  concerning  the  nature  of  these  compounds, 
it  seems  pretty  well  established  that  when  flesh  undergoes  de- 
composition, in  the  absence  of  oxygen,  certain  unstable  chemical 
combinations  are  formed  which  act  as  violent  poisons.  Selmi^ 
followed  by  most  toxicologists,  believes  these  compounds  to  be 
alkaloids,  analogous  to  the  vegetable  alkaloids,  such  as  morphine, 
atropine,  etc.  Casali,  on  the  other  hand,  disagrees  with  this 
opinion,  and  believes  the  ptomaines  to  be  amido  compounds. 
Husemann  regards  Casali's  hypothesis  as  plausible,  inasmuch  as 
the  formation  of  amido  compounds  in  animal  and  vegetable 
bodies  during  decomposition  is  well  established. 

The  form  of  poisoning  due  to  the  organisms  of  putrefaction 
is  not  infrequent.  An  extensive  outbreak  of  this  nature  occurred 
at  Andelfingen,  in  Switzerland,  in  1839.  A  musical  festival 
was  held,  at  which  there  were  over  700  present.  Out  of  these 
444  were  suddenly  attacked  by  violent  gastro-enteric  and  nervous 
symptoms.  Ten  of  the  patients  died.  The  illness  was  traced  to 
roast  veal,  which  had  been  kept  in  a  warm  place  for  two  days 
after  roasting,  and  which  was  probably  in  a  state  of  partial 
decomposition. 

The  class  of  cases  which  seem  more  probably  due  to  the 
action  of  ptomaines  or  related  poisons,  have  been  frequently 
observed  after  eating  sausages  or  canned  meats.  Sausage  poi- 
soning is  not  rarely  observed  in  Germany.  It  has  been  ascer- 
tained that  the  internal  portions  of  the  sausage  are  the  most 
poisonous.  It  is  supposed  that  the  ptomaines,  which  are  formed 
in  the  absence  of  oxygen,  are  the  active  agents  in  the  pro- 
duction of  the  train  of  symptoms.  Poisoning  by  canned  meat 
seems  to  be  due  to  a  similar  poison. 


102  TEXT-BOOK   OF    HYGIENE. 

In  July,  1885,  an  outbreak  of  disease,  due  to  eating  un- 
wholesome beef,  was  caused  at  Momence,  Illinois.  Chemical 
examination  of  specimens  of  the  meat  showed  the  presence  of 
an  alkaloidal  body,  which  was  believed  to  be  a  ptomaine,  but  its 
nature  was  not  definitely  determined. 

Fish,  oysters,  crabs,  and  lobsters  frequently  give  rise  to 
symptoms  of  poisoning.  In  most  of  these  cases  the  poisoning 
is  probably  due  to  partial  decomposition,  but  it  is  a  well-known 
fact  that  oysters  and  crabs  are  unfit  for  food  at  certain  seasons. 
Some  persons,  however,  are  subjects  of  a  peculiar  idiosyncrasy, 
in  consequence  of  which  shell-fish  always  produce  certain  un- 
pleasant symptoms,  among  which  nettle-rash  and  a  choleraic 
attack  are  most  prominent. 

That  form  of  fish-poisoning  known  among  the  Spaniards 
in  the  West  Indies  as  siguatera  is,  however,  very  grave.  The 
mortality  is  large,  and  in  many  cases  death  succeeds  rapidly 
upon  the  attack.  The  symptoms  are  as  follow:  Sometimes 
suddenly,  sometimes  preceded  by  dizziness  and  indistinct  vision, 
great  prostration  and  paralysis  occur.  Often  death  follows  the 
onset  of  the  symptoms  in  two  and  three  hours ;  exceptionally  in 
less  than  twenty  minutes.  In  most  cases  consciousness  is  totally 
lost ;  in  others  it  persists,  with  interruptions,  until  death.  Sensa- 
tion and  the  powers  of  speech  and  deglutition  fail.  The  jaw- 
muscles  become  paralyzed,  the  pulse  is  slowed,  and- the  tem- 
perature diminished.  There  is  sometimes  vomiting,  but  no 
purging.  The  secretion  of  the  kidneys  is  also  checked.  Dr. 
McSherry  states1  that  he  has  seen  all  these  symptoms  produced 
by  eating  oysters,  lobsters,  and  crabs  unseasonably. 

In  Russia  a  form  of  poisoning  has  often  been  observed 
which  results  from  eating  salted  sturgeon.  In  the  fresh  state 
these  fish  are  perfectly  wholesome,  but  when  salted  and  eaten 
raw  they  produce  a  very  fatal  illness.  The  mortality  is  said  to 
reach  50  per  cent,  of  those  attacked.  No  cases  traceable  to 
this  cause  have;  been  observed  in  this  country. 

1  Health  and  How  to  Promote  it,  p.  143. 


FOODS    OF    ANIMAL    ORIGIN.  103 

It  has  been  shown,  beyond  question,  that  the  flesh  of  beeves 
suffering,  when  killed,  from  splenic  fever,  will  produce  this 
disease  in  the  human  subject. 

In  187-1  an  extensive  and  violent  outbreak  of  an  acute 
disease,  characterized  by  vomiting  and  purging,  fever  and  dizzi- 
ness, occurred  at  Middelburg,  in  Holland.  Three  hundred  and 
forty-nine  persons  were  attacked,  of  whom  6  died.  The  out- 
break was  traced  to  eating  liver-sausage  (Leberwurst),  in  which 
the  characteristic  bacillus  of  splenic  fever  was  found  on  micro- 
scopic examination.  In  July,  1877,  an  outbreak  of  choleraic 
disease,  from  eating  carbuncular  meat,  occurred  in  the  town  of 
Wurzen.  In  the  latter  epidemic  the  bacillus  of  splenic  lever 
(Bacillus  anthracis)  was  found  in  the  intestinal  canal  and  in  the 
blood  of  those  attacked. 

In  Detmold,  in  Germany,  an  outbreak  of  violent  gastro- 
intestinal inflammation,  accompanied  by  high  fever,  occurred. 
Among  the  150  persons  attacked  3  died.  The  disease  was 
traced  to  eating  the  meat  of  a  cow  suffering,  before  death, 
from  pleurisy  (probably  pleuro-pneumonia).  In  view  of  the 
somewhat  extensive  prevalence  of  this  disease  among  cattle  in 
this  country  at  the  present  time,  the  record  of  this  outbreak  may 
suggest  to  sanitary  authorities  some  measures  for  the  prevention 
of  similar  epidemics  on  this  side  of  the  Atlantic. 

In  July,  1880,  72  persons  who  had  eaten  of  certain  beef 
and  ham-sandwiches  in  Welbeck,  England,  were  attacked  by 
choleraic  diarrhoea;  4  of  the  cases  died.  Inflammation  of  the 
lungs  and  small  intestines  were  the  most  prominent  pathological 
conditions  found  post-mortem.  The  smaller  blood-vessels  of  the 
kidneys  were  filled  with  finger-shaped  bacilli,  which,  when  cul- 
tivated and  inoculated  into  guinea-pigs,  rats,  and  white  mice, 
produced  similar  pathological  conditions.  At  Nottingham, 
England,  in  1881,  a  number  of  persons  were  attacked  by  a 
similar  train  of  symptoms  after  eating  baked  pork.  One  case 
terminated  fatally  out  of  the  15  attacked.  It  is  uncertain 
whether  the   meat  in  these   two  instances  was  from  diseased 


104  TEXT-BOOK    OF   HYGIENE. 

animals  or  whether  it  had  undergone  partial  decomposition. 
The  former  is  the  more  probable  supposition,  although  the 
organisms  found  were  neither  those  of  splenic  fever  nor  swine 
plague,  but  resembled  those  of  symptomatic  anthrax  (black  leg 
or  black  quarter). 

Whether  the  flesh  of  tuberculous  animals  can  communicate 
tuberculosis  to  the  consumer  is  still  an  unsettled  question. 
Foreign  veterinarians  and  hygienists  who  have  studied  the 
question  incline  to  the  view  that  there  is  danger  of  such  trans- 
mission. At  the  International  Sanitary  Congress  of  1883,  at 
Brussels,  the  subject  was  discussed,  and  M.  Lydtin,  the  chief 
veterinary  surgeon  of  the  Grand  Duchy  of  Baden,  submitted 
the  following  propositions,  which  were  adopted  by  the  Congress : 

1.  That  the  flesh  and  viscera  of  tuberculous  animals  may 
be  used  as  food,  provided  the  disease  is  only  commencing,  the 
lesions  extending  but  to  a  small  part  of  the  body,  the  lymphatic 
glands  being  still  healthy;  provided  the  tubercle  centres  have 
not  undergone  softening,  and  provided  the  carcass  is  well  nour- 
ished and  the  flesh  presents  the  characters  of  meat  of  the  first 
quality.  2.  That  the  flesh  of  animals  showing  very  pronounced 
tuberculous  infection  should  be  saturated  with  petroleum,  and 
afterward  burned  under  the  direction  of  the  police.  3.  That  the 
milk  from  cows  affected  with  pulmonary  phthisis,  or  suspected  of 
having  it,  should  not  be  consumed  by  man  or  other  animals, 
and  the  sale  of  it  should  be  strictly  prohibited. 

The  congress  for  the  study  of  tuberculosis,  which  met  in 
Paris  in  1888,  adopted  resolutions  of  a  more  decided  character 
against  the  use  of  meat  and  milk  from  tuberculous  animals. 

Certain  animals  can  devour  with  impunity  substances 
which  are  intensely  poisonous  to  human  beings.  The  flesh  of 
the  animals  may  be  impregnated  with  these  poisons,  and  cause 
serious  and  fatal  illness  in  persons  partaking  of  it.  In  this  way 
may,  perhaps,  be  explained  the  cases  of  poisoning  sometimes 
following  the  eating  of  partridges  and  other  birds. 

The  prevention  of  disease   from  tainted  meat  is  one  of  the 


FOODS   OF    ANIMAL    ORIGIN.  105 

most  important  problems  of  public  hygiene.  Food  animals 
should  be  inspected  by  qualified  inspectors  before  slaughtering, 
to  exclude  animals  suffering  from  diseases  that  would  vitiate  the 
meat.  When  the  meat  is  exposed  for  sale  upon  the  dealer's 
stall  it  should  be  again  inspected,  and  all  found  unfit  for  use  as 
food  confiscated  and  destroyed.  Meat,  in  which  the  presence 
of  trichinae  or  other  parasites  is  suspected,  should  be  examined 
microscopically.1 

Eggs. — Although  eggs  contain  a  large  amount  of  the  pro- 
teid  and  fatty  alimentary  principles,2  their  value  as  food  has 
probably  been  greatly  overrated.  The  savory  taste  and  ready 
digestibility  of  eggs  has,  however,  rendered  them  a  popular 
article  of  food.  For  obvious  reasons,  the  eggs  of  the  common 
barn-yard  fowl  are  most  frequently  used,  those  of  ducks  and 
geese  being  far  inferior  in  flavor  to  the  first  named,  and  being 
likewise  less  easily  obtained. 

The  method  of  cooking  eggs  is  generally  supposed  to  have 
considerable  influence  upon  their  digestibility.  According  to 
Dr.  Beaumont's  experiments  made  on  Alexis  St.  Martin,  raw 
ea-o-s  are  digested  in  one  and  a  half  to  two  hours,  fresh-roasted 

©O  ©  7 

in  two  hours  and  fifteen  minutes,  soft-boiled  or  poached  in  three 
hours,  and  hard-boiled  or  fried  in  three  and  a  half  hours.  These 
experiments  are,  however,  of  very  little  value  as  a  basis  for 
general  conclusions.  It  is  probable  that  a  hard-boiled  egg  is 
quite  as  easily  digested  in  the  healthy  stomach  as  a  raw  one,  if 
care  be  taken  to  masticate  it  well  and  eat  bread  with  it,  so  that 
it  is  introduced  into  the  stomach  in  a  finely-divided  state. 

Eggs  readily  undergo  putrefaction,  when  sulphuretted 
hydrogen  is  formed  in  them  in  large  quantities.  When  this 
has  taken  place  they  are  manifestly  unfit  to  be  used  as  food. 

1  The  prevention  of  the  diseases  of  animals  by  National  and  State  authorities  is  one  of 
the  most  logical  and  thorough-going  means  of  preventing  disease  from  unwholesome  meat.  The 
American  Public  Health  Association  has  for  some  years  devoted  considerable  attention  to  the 
investigation  of  the  diseases  of  animals  and  means  for  their  prevention.  The  Department  of 
the  Interior  of  the  National  Government  has  likewise  made  the  diseases  of  cattle  and  hogs  a 
subject  of  study  and  published  some  valuable  reports  thereon. 

*  See  analysis  iu  Table  VUI. 


106  TEXT-BOOK    OF  HYGIENE. 

FOODS    OF   VEGETABLE    ORIGIN. 

Bread. — The  various  cereal  grains,  when  ground  into  flour, 
are  used  in  making  bread.  The  flours  of  wheat,  rye,  barley, 
buckwheat,  and  Indian  corn  are  almost  exclusively  used  in  bread- 
making.  The  bran  or  cortical  portion  of  grain  contains  a  larger 
percentage  of  proteid  principles  than  the  white  internal  portion ; 
hence,  flours  made  from  the  whole  grain  (bran-flour,  Graham 
flour)  if  finely  ground  are  more  nutritious  than  the  white  flours. 
The  latter  are,  however,  more  digestible,  and  hence  furnish  a 
larger  proportion  of  nutriment,  because  the  principles  contained 
in  white  flours  are  absorbed  and  assimilated  to  a  greater  degree. 

Good  bread  should  be  light,  porous,  and  well  baked.  The 
lightness  and  porosity  are  due  to  carbon-dioxide  gas  imprisoned 
in  cavities  of  the  dough  during  the  process  of  bread-making. 
By  adding  yeast  to  the  dough  a  fermentation  is  caused  in  the 
latter,  in  consequence  of  which  a  portion  of  the  starch  is  con- 
verted into  sugar,  and  then  into  alcohol  and  carbon  dioxide. 
During  the  process  of  mixing  the  dough  the  entire  mass  becomes 
permeated  by  the  gas,  which,  on  heating,  expands  and  leaves 
the  numerous  large  and  small  cavities  throughout  the  loaf  which 
indicate  properly-made  bread. 

Instead  of  yeast  some  persons  use  leaven,  which  is  simply 
a  portion  of  fermenting  dough,  saved  from  previous  baking.  A 
small  quantity  of  this  added  to  a  mass  of  dough  starts  up  the 
fermentation  in  a  similar  manner  to  that  of  yeast. 

The  production  of  carbon  dioxide  by  fermentation  in  the 
dough  goes  on  at  the  expense  of  part  of  the  starch.  It  has 
been  proposed,  therefore,  to  supply  the  carbon  dioxide  from 
without,  thus  saving  the  entire  amount  of  the  carbohydrates 
present  in  the  flour.  This  is  accomplished  in  two  ways — 
first,  by  the  use  of  some  alkaline  carbonate  or  bicarbonate 
(bicarbonate  of  sodium,  carbonate  of  ammonium),  the  carbon 
dioxide  being  set  free  on  the  application  of  heat ;  or,  secondly, 
by  forcing  the  gas,  previously  prepared,  into  the  dough  by  means 
of  machinery. 


FOODS    OF    VEGETABLE    ORIGIN. 


107 


Flour  is  not  infrequently  adulterated  with  chalk,  gypsum, 
pipe-clay,  and  similar  articles.  These  are  easily  detected  by 
adding  a  mineral  acid,  which  produces  effervescence  when  it 
comes  in  contact  with  the  alkaline  carbonate  used  as  adulterant. 
Potato-  and  bean-  meals  are  also  used  as  adulterants  of  the  higher 


grades  of  flour. 


Bakers  often  mix  alum  with  inferior  grades  of 


flour.  This  imparts  a  greater  degree  of  whiteness  to  the  bread, 
and,  in  addition,  enables  it  to  retain  a  large  proportion  of  water, 
thereby  increasing  the  weight  of  the  loaf. 

Formerly  diseased  grain  (ergotized  rye)  often  caused  out- 
breaks of  disease  when  the  flour  made  from  the  diseased  grain 
was  used  in  bread-making.  At  the  present  time  such  accidents 
rarely  occur.  In  some  parts  of  Italy  it  is  said  that  an  endemic 
disease — pellagra — is  caused  by  the  consumption  of  diseased 
Indian  corn.  The  evidence  in  favor  of  this  view  is,  however, 
not  unquestioned. 

Potatoes  and  rice  are  often  used  with  satisfaction  as  substi- 
tutes for  bread.  They  both  contain  a  large  proportion  of  carbo- 
hydrates. Indian  corn  (hominy)  and  oatmeal  are  likewise 
wholesome  and  nutritious  foods  of  this  class. 

The  leguminous  seeds  (beans,  peas,  lentils)  furnish  a  food 
containing  a  large  percentage  of  proteids.  According  to  the 
analyses  of  Kcenig1  the  average  composition  of  the  most  fre- 
quently used  legumes  in  the  dried  condition  is  as  follows  : — 

Table  XIII. 


Beans. 

Peas. 

Lentils. 

Ground-nuts.2 

Water,  per  cent.     .     .     . 

Solids,  per  cent.      .     .     . 

13.6 

86.4 

14.3 

85.7 

12.5 

87.5 

6.5 
93.5 

Proteids,  per  cent.      .     . 

Fats 

Carbohydrates,  per  cent. 
Cellulose,  per  cent.     .     . 
Ash 

23.1 
2.3 

53.6 
3.9 
3.5 

22.6 
1.7 

53.2 
5.5 

2.7 

24.8 

1.9 

54.7) 

3.6/ 
2.5 

28.2 
46.4 

15.7 

3.2 

1  Die  Menschlichen  Nahrungs  unci  Genussmittel,  ii,  p.  288. 

3  The  American  pea-nut,  the  fruit  or  nut  of  Arachis  hypogcea. 


108  TEXT-BOOK   OF    HYGIENE. 

Beans,  peas,  and  lentils  are  often  added  to  other  articles  of 
food  with  advantage.  In  recent  years  an  important  article  of 
food  for  armies  has  been  made  of  various  legumes  ground  into 
flour  and  mixed  with  fat,  dried  and  powdered  meat,  salt,  and 
spice.  This  constitutes  the  so-called  "  Erbswurst,"  or  pea-sausage, 
which  formed  such  an  important  part  of  the  dietary  of  the  German 
army  in  the  Franco-German  war  of  1871.  Bean-  and  pea-  meals 
are  also  used  sometimes  as  additions  to  other  flours  in  bread- 
making.  The  dried  leguminous  fruits  cannot  be  used  as  regular 
articles  of  diet,  however,  as  they  soon  pall  upon  the  taste,  and 
produce  indigestion,  nausea,  and  other  intestinal  derangements. 

Green  Vegetables. — The  plants  usually  classed  together  as 
"  vegetables,"  the  products  of  the  market-garden  or  truck-farm, 
comprise  cabbages,  turnips,  parsnips,  onions,  beets,  carrots, 
tomatoes,  lettuce,  green  peas  and  beans,  and  similar  articles. 
They  all  contain  a  large  proportion  of  water,  a  variable  propor- 
tion of  sugar,  and  a  small  percentage  of  proteid  principles. 
Much  of  their  palatability  and  digestibility  depend  upon  the 
methods  by  which  they  are  prepared  for  the  table.  All  garden 
vegetables  should  be  used  soon  after  being  gathered,  as  they 
rapidly  undergo  decomposition,  and  are  liable  to  produce 
derangements  of  the  digestive  organs  if  used  under  these 
conditions. 

Fruits  and  nuts  generally  contain  large  quantities  of  sugar 
and  fats.  They  form  agreeable  additions  to  other  articles  of 
diet,  but  are  insufficient  to  sustain  life.  The  use  of  fruits  usually 
produces  copious  intestinal  evacuations,  and  they  are,  therefore, 
especially  to  be  recommended  to  persons  of  sedentary  occupations, 
in  whom  torpidity  of  the  bowels  is  so  frequently  present. 

Condiments. — Various  aromatic  herbs  and  seeds  are  used 
as  additions  to  other  articles  of  food,  to  increase  their  sapidity 
and  to  promote  a  larger  flow  of  saliva  and  gastric  juice,  and  so 
assist  digestion.  Mustard,  pepper,  allspice,  and  vinegar  are  the 
principal  condiments.  Within  certain  limits  they  are  not  in- 
jurious, but  the  tendency  in  the  use  of  all  stimulants  is  to 


COOKING.  109 

exceed  a  healthful  limit.     Condiments,  as  well  as  other  stimu- 
lants, should  be  used  in  moderation. 

COOKING. 

Much  more  attention  than  is  generally  given  should  be  paid 
by  physicians  to  the  culinary  art.  The  manner  in  which  food  is 
cooked  has  no  little  influence  upon  its  digestibility.  There  can 
be  no  question  that  the  extreme  prevalence  of  functional  indi- 
gestion in  this  country  is  almost  exclusively  dependent  upon  bad 
cooking. 

The  various  methods  of  cooking  are  boiling,  frying,  roast- 
ing, broiling,  and  baking.  By  either  of  these  methods  food  can 
be  cooked  so  as  to  be  palatable  as  well  as  digestible  ;  on  the  other 
hand,  the  choicest  article  can  be  utterly  spoiled  and  rendered 
unfit  to  be  taken  into  the  human  stomach.  It  depends,  therefore, 
not  so  much  upon  the  method  of  cooking,  as  upon  the  knowledge 
and  art  of  the  cook. 

Boiling. — Meats  of  all  kinds  are  rendered  tender  and  di- 
gestible by  boiling.  In  order  to  retain  the  flavor  of  meat,  the 
water  should  be  boiling  when  the  meat  is  put  into  it.  By  the 
heat  of  the  boiling  water  the  albumen  on  the  outside  of  the 
meat  is  coagulated  and  the  juices  and  flavor  retained  within. 
After  a  few  minutes  the  temperature  of  the  water  should  be  re- 
duced to  71°  to  77°  C.  (160°  to  170°  F.),  and  maintained  at  that 
height  until  the  meat  is  tender.  By  this  process  a  much  more 
savory  piece  of  beef,  mutton,  or  fowl  can  be  obtained  than  where 
the  meat  is  put  into  cold  water  and  thus  gradually  heated.  The 
latter  method  is,  however,  the  proper  one  to  be  followed  when 
good  soup  or  broth  is  desired. 

In  boiling  vegetables,  as  much  care  is  necessary  as  in  boil- 
ing meat  or  fish.  Potatoes  and  rice  should  be  steamed,  rather 
than  boiled. 

The  difficulty  of  obtaining  a  good  cup  of  coffee,  especially 
in  the  northern  portion  of  the  United  States,  illustrates  the  pre- 
vailing ignorance  upon  one  of  the  simplest  points  in  the  art  of 


110  TEXT-BOOK   OF   HYGIENE. 

cooking.  Coffee  should  never  be  served  in  the  form  of  a  de- 
coction; that  is  to  say,  it  should  never  be  boiled.  Properly  made 
it  is  an  infusion,  like  tea,  which  no  one  ever  thinks  of  boiling. 
The  difference  between  an  infusion  (especially  if  made  by  per- 
colation) and  a  decoction  of  coffee  can  only  be  appreciated  by 
those  who  have  enjoyed  the  one  and  endured  the  other. 

Frying. — Frying,  if  properly  done,  is  really  nothing  less 
nor  more  than  boiling  in  oil  or  fluid  fat  of  some  kind.  Olive- 
oil  is  preferable,  but  is  not  essential ;  butter,  beef-drippings,  lard, 
or  probably  cotton-seed  oil  may  be  substituted  for  it  without 
disadvantage.  The  principle  of  frying  depends  upon  the  fact 
that  the  temperature  of  oil  can  be  raised  to  such  a  height  as  to 
produce  instant  coagulation  of  the  surface  of  meat,  fish,  or  other 
object  immersed  in  it  while  hot ;  this  film  of  coagulated  albu- 
men imprisons  the  juices  and  flavors  of  the  meat  or  fish,  and  pre- 
vents the  fat  entering  and  soaking  the  fibres  with  grease.  Small 
fish  or  birds,  properly  fried,  are  justly  regarded  as  delicacies  by 
connoisseurs,  but  the  process  of  saturating  these  objects  with  fat 
while  gradually  heating  them  produces  a  dish  that  is  anything 
rather  than  grateful  to  the  palate,  or  conducive  to  good  digestion. 

Roasting. — The  fame  of  "  the  roast  beef  of  Old  England" 
has  passed  into  song,  but,  at  the  present  day,  beef  and  other 
meats  are  rarely  roasted,  either  in  this  country  or  abroad.  As 
Sir  Henry  Thompson  well  expresses  it,1  "the  joint,  which  for- 
merly turned  in  a  current  of  fresh  air  before  a  well-made  fire,  is 
now  half  stifled  in  a  close  atmosphere  of  its  own  vapors,  very 
much  to  the  destruction  of  the  characteristic  flavor  of  a  roast." 
It  is  probable  that  the  old  method  of  roasting  before  an  open  fire 
produced  not  only  the  most  savory,  but  likewise  the  most  nu- 
tritious and  digestible,  meat.  It  is  much  to  be  regretted  that  the 
process  has  fallen  so  greatly  into  disuse. 

Broiling  and  Baiting. — These  methods  of  cooking  are 
modifications  of  the  process  of  roasting.  Meats  or  fish,  care- 
fully broiled  or  baked,  preserve  their  natural  juices  and  flavors 

1  Food  and  Feeding,  p.  45.    London,  1880. 


ALIMENTARY    BEVERAGES.  Ill 

to  a  great  extent,  and  retain  their  digestibility  and  nutritious 
properties.  Of  all  methods  of  cooking  these  are  probably  best 
known  and  most  satisfactorily  applied  in  this  country.1 

ALIMENTARY    BEVERAGES. 

The  alimentary  beverages  may  be  divided  into  two  classes, 
— those  depending  for  their  effects  upon  the  alcohol  they  contain, 
and  those  whose  active  principles  reside  in  certain  alkaloids. 
They  are  used  chiefly  as  digestive  and  nervous  stimulants. 

BEVERAGES  CONTAINING  ALCOHOL. 

The  physiological  action  of  alcohol  has  been  pretty  fully 
worked  out  by  Binz  and  his  pupils,  and  by  other  experimenters. 
From  these  researches,  it  appears  that  the  first  effect  of  taking 
alcohol,  sufficiently  diluted,  into  the  stomach,  is  to  increase  the 
flow  of  the  saliva  and  gastric  juice.  This  effect  is  probably  re- 
flex, and  results  from  a  stimulation  of  nerve  terminations  in  the 
stomach.  The  alcohol  is  rapidly  absorbed,  and  is  carried  in  the 
blood,  without  undergoing  chemical  change,  to  the  nervous 
centres,  lungs,  and  tissues  generally.  In  the  brain  the  alcohol 
prooably  enters  into  combination  with  the  nervous  tissue, 
modifying  the  normal  activity  of  the  various  centres,  either 
increasing  the  activity,  if  the  alcohol  is  in  small  quantity  (stim- 
ulating effect),  or  diminishing  it  if  in  larger  quantity  (depressing 
effect),  or  entirely  suspending  the  activity  of  the  centres,  if  in 
sufficiently  large  quantity  (paralyzing  effect). 

Alcohol  stimulates  the  vasodilator  nerves,  causing  dilata- 
tion of  the  smaller  vessels ;  in  consequence  of  this  the  blood  is 
largely  sent  to  the  periphery  of  the  body ;  the  blood-pressure 
diminishes,  and  heat-radiation  is  increased.  At  the  same  time 
a  portion  of  the  alcohol  is  used  up  in  the  lungs  in  the  produc- 
tion of  animal  heat,  thus  economizing  the  expenditure  of  fats 

1  Every  one  interested  in  the  proper  application  of  the  principles  of  cookery  should 
study  the  Lomb  prize  essay  of  the  American  Public  Health  Association,  by  Mary  Hinman  Abel, 
upon  "Practical,  Sanitary,  and  Economic  Cooking."  This  little  book  can  be  obtained  of  Dr.  I. 
A.  Watson,  Secretary,  Concord,  N.  H. ;  price,  25  cents.  See,  also,  an  essay  on  "The  Art  of  Cook- 
ing," by  Edward  Atkinson,  LL.D.,  in  Popular  Science  Monthly,  November,  18S9. 


112  TEXT-BOOK   OF    HYGIENE. 

and  proteids,  and  acting  as  a  true  respiratory  food.  Alcohol 
does  not  contribute  nutritive  material  to  the  body ;  it  only  per- 
mits that  which  is  stored  up  to  be  saved  for  other  uses,  by  fur- 
nishing easily-oxidizable  (combustible)  material  for  carrying  on 
the  respiratory  process,  and  supplying  animal  heat. 

During  the  use  of  alcohol  the  excretion  of  urea  is  dimin- 
ished. This  shows  that  waste  of  tissue  is  retarded  in  the 
body. 

Regarding  the  statement  of  some  authorities  that  alcohol  does 
not  undergo  any  change  in  the  body,  but  is  excreted  unchanged, 
Binz  asserts1  that  alcohol  appears  in  the  urine  only  when 
exceptionally  large  quantities  have  been  taken,  and  then  in  very 
small  proportion.  It  is  not  excreted  by  the  lungs,  the  peculiar 
odor  of  the  breath  being  due  not  to  the  alcohol,  but  to  the 
volatile  aromatic  ether,  which  is  oxidized  with  greater  difficulty, 
and  so  escapes  unchanged. 

While  alcohol  produces  subjectively  an  agreeable  sensation 
of  warmth  in  the  stomach  and  on  the  surface  of  the  body,  the 
bodily  temperature  is  not  raised.  The  subjective  sensation  is 
due  to  the  dilatation  of  the  blood-vessels  and  the  sudden  hyper- 
semia  of  those  parts. 

During  fevers  and  other  exhausting  diseases,  alcohol  is 
invaluable  to  prevent  waste  of  tissue  and  sustain  the  strength. 
It  does  not  act  merely  as  a  stimulant  to  the  circulation  and 
nervous  system,  but,  as  above  pointed  out,  saves  the  more  stable 
compounds  by  furnishing  a  readily  oxidizable  respiratory  food. 

When  taken  in  small  doses  by  healthy  persons,  alcohol 
diminishes  the  temperature  by  increasing  heat-radiation.  When 
large  quantities  are  taken,  the  bodily  temperature  is  reduced  by 
diminishing  heat  production,  as  well  as  by  increased  radiation. 
This  is  shown  in  the  condition  known  as  dead-drunkenness,  in 
which  the  temperature  is  sometimes  depressed  as  much  as  20  °  F. 
below  the  normal.  Cases  in  which  the  temperature  sank  to  75°, 
78.8°,  and  83°  F.  have  been  reported,  with  recovery  in  all  cases. 

1  Realencyclopaedie  d.  ges.  Heilk.,  Bd.  I,  p.  183. 


BEVERAGES  CONTAINING  ALCOHOL.  113 

The  constant  use  of  alcohol  produces  in  all  the  organs  an 
excess  of  connective  tissue,  followed  by  fatty  degeneration  and 
the  condition  known  as  cirrhosis.  The  organs  most  frequently 
affected  are  the  stomach,  liver,  and  kidneys.  Serious  pathological 
alterations  also  occur  in  the  circulatory,  respiratory,  and  nervous- 
systems. 

Alcohol  is  not  necessary  to  persons  in  good  health.  Prob- 
ably most  persons,  regardless  of  their  state  of  health,  do  better 
without  it.  Its  habitual  use  in  the  form  of  strong  liquors  is 
to  be  unreservedly  condemned.  The  lighter  wines  and  malt 
liquors,  if  obtained  pure,  may  be  consumed  in  moderate  quanti- 
ties without  ill  effects.  Even  in  these  forms,  however,  the  use 
of  alcohol  should  be  discouraged  or,  perhaps,  prohibited  in  the 
young. 

Neither  in  hot  nor  in  cold  climates  is  alcohol  necessary  to 
the  preservation  of  health,  and  its  moderate  use  even  produces 
more  injury  than  benefit.  The  Polar  voyager  and  the  East 
India  merchant  are  alike  better  off  without  alcohol  than  with  it. 

It  has  long  been  a  prevalent  belief  that  the  use  of  alcohol 
enables  persons  to  withstand  fatigue  better  than  where  no  alcohoL 
is  used.  A  large  amount  of  concurrent  testimony  absolutely 
negatives  this  belief.1 

The  predisposition  to  many  diseases  is  greatly  increased  by 
the  habitual  use  of  alcohol.  Sun-stroke,  the  acute  infectious 
diseases,  and  many  local  organic  affections  attack,  by  preference, 
the  intemperate.  A  recent  collective  investigation  by  the  British 
Medical  Association  brought  out  the  fact  that  croupous  pneu- 
monia is  vastly  more  fatal  among  the  intemperate  than  amons; 
those  who  abstained  from  the  use  of  alcoholic  liquors. 

A  further  investigation  by  Baer  has  shown  that  the  average 
expectation  of  life  among  users  and  dealers  in  alcoholic  liquors 
is  very  much  shortened.  The  following  table  gives  a  compara- 
tive view  of  the  expectation  of  life  in  those  who  abstained  from 
and  those  who  used  alcohol: — 

1  See  Parkes'  Hygiene,  6th  ed:,  vol.  i,  pp.  31&-3271 


114 


TEXT-BOOK    OF   HYGIENE. 
Table  XIV. 

EXPECTATION    OF   LIFE. 


Age. 

Abstainers. 

Alcohol  Users. 

At  25 

32.08  years. 
25.92      " 
19.92      " 
14.45       " 
9.62       " 

26.23  years. 
20.01       " 

"35 

"45 

15.19      " 

"55 

11.16       " 

"65 

8.04      " 

Table  XV  shows  the  influence  of  alcohol  upon  the  mortality 
from  various  diseases : — 

Table  XY. 


General  Male  Popu- 
lation (per  cent.). 

Alcohol  Venders 
(per  cent.). 

11.77 
30.36 
9.63 
1.46 
1.40 
2.99 
2.49 
22.49 

14.43 

36.57 

Pneumonia  and  pleuritis      .... 

11.44 
3.29 
2.11 

4.02 
3.70 

7.05 

Alcohol  as  a  beverage  is  consumed  in  the  various  forms  of 
spirits,  wines,  and  fermented  liquors.  The  varieties  of  spirits 
most  frequently  used  are  brandy,  whisky,  rum,  and  gin.  They 
are  all  procured  by  distillation. 

Brandy  is  distilled  from  fermented  grape-juice,  and  has  a 
characteristic  aromatic  flavor.  When  pure  and  mellowed  with 
age  it  is  the  most  grateful  to  the  palate  of  all  distilled  spirits. 

Whisky  is  distilled  from  barley,  rye,  oats,  corn,  or  potatoes. 
Each  of  these  has  a  peculiar  flavor,  depending  upon  the  par- 
ticular volatile  ether  formed  during  the  distillation.  Rye-,  barley-, 
and  corn-  whiskies  are  almost  exclusively  used  in  this  country. 


BEVERAGES  CONTAINING  ALCOHOL.  115 

Rum  is  distilled  from  molasses,  and  is  a  favorite  ingredient 
in  hot  punches.  It  is  often  used  with  milk,  eggs,  and  sugar,  in 
the  preparation  of  eggnog,  a  highly-nutritious,  stimulating  drink, 
which  is  often  prescribed  with  great  benefit  in  acute  and  chronic 
wasting  diseases. 

Gin  is  an  ardent  distilled  spirit,  flavored  with  oil  of  juniper. 
It  has  a  widely-spread  popular  reputation  as  a  cure  for  kidney 
diseases,  but  is  probably  oftener  responsible  for  the  production 
of  these  diseases  than  for  their  cure. 

All  of  the  above-mentioned  liquors  contain  from  40  to  60 
per  cent,  of  alcohol,  and  should  always  be  diluted  before  being 
taken  into  the  stomach,  in  order  to  prevent  the  local  irritant 
effects  of  the  alcohol  upon  the  gastric  mucous  membrane. 

Wine  is  the  product  of  the  alcoholic  fermentation  of  the 
saccharine  constituents  of  fruits.  Wine  is  usually  derived  from 
the  grape,  though  other  fruits  may  also  furnish  it.  The  stronger 
wines  (sherry,  port,  madeira)  contain  from  16  to  25  per  cent. 
of  alcohol.  The  lighter  wines  (hock,  red  and  white  Bordeaux 
and  Burgundy  wines,  champagnes)  contain  from  6  to  15  per 
cent,  of  alcohol.  Some  also  contain  considerable  free  carbonic 
acid  (sparkling  wines),  of  which  the  champagnes  are  types.  The 
red  and  white  Bordeaux  and  Rhine  wines  are  probably  the 
least  objectionable  of  these  beverages  for  habitual  use.  They 
contain  sufficient  alcohol  to  be  lightly  stimulant,  have  a  pleasant 
acid  flavor,  and  are  least  likely  to  produce  the  bad  effects  which 
usually  follow  in  the  wake  of  the  habitual  use  of  the  stronger 
wines  or  ardent  spirits. 

Preference  should  be  given  to  the  wines  of  domestic  manu- 
facture, on  account  of  the  great  probability  of  adulteration  of  the 
favorite  brands  of  foreign  wines.  Many  of  the  California,  Vir- 
ginia, New  York,  and  Ohio  wines  compare  very  favorably  in 
flavor  with  those  imported  from  abroad.  The  more  reasonable 
cost  of  these  domestic  wines  is  also  a  point  in  their  favor. 

Cider  is  the  fermented  juice  of  apples.  It  frequently  pro- 
duces unpleasant  gastric  and  intestinal  disturbances  when  drunk, 


116  TEXT-BOOK    OF   HYGIENE. 

on  account  of  the  large  quantity  of  malic  acid  contained  in  it. 
Although  it  is  usually  ranked  as  a  "  temperance  drink,"  it  is 
quite  capable  of  causing  intoxication  when  consumed  in  large 
quantities. 

Beer  is  the  fermented  extract  of  barley,  mixed  with  a 
decoction  of  hops  and  boiled.  It  should  be  prepared  only  of 
malt,  hops,  yeast,  and  water,  and  should  contain  from  3  to 
4  per  cent,  of  alcohol,  5  to  6  per  cent,  of  extract  of  malt 
and  hops,  2  to  4  per  cent,  of  lactic  and  acetic  acids,  and  from 
\  to  \  per  cent,  of  carbonic  acid.  This  ideal  is,  how- 
ever, rarely  attained  in  the  article  sold  by  the  liquor  dealer. 
Numerous  adulterations  are  practiced  on  the  unsuspecting  con- 
sumer. The  hops  are  frequently  substituted  by  aloes,  calamus, 
and  ginger,  or  by  the  more  deleterious  picric  acid  or  picrotoxin. 
The  rich  brown  color,  sweetness,  body,  and  creamy  foam  are 
produced  by  caramel  and  glycerin.  The  more  expensive  barley- 
malt  is  substituted  by  starch  and  rice,  or  grape-sugar  and 
molasses. 

Ale,  porter,  and  brown-stout  are  merely  varieties  of  beer — 
some  containing  more  sugar,  others  more  extractive  matter. 

Beer  and  its  correlatives  have  considerable  dietetic  value, 
owing  not  merely  to  the  alcohol  they  contain,  but  largely  to  the 
sugar  and  acids  entering  into  their  composition.  When  used  to 
excess  they  often  cause  a  considerable  accumulation  of  fat. 

Kumys  is  the  national  beverage  of  the  nomadic  tribes  of 
Tartary.  It  consists  of  the  milk  of  mares  which  has  undergone 
fermentation,  partly  lactic  and  partly  alcoholic  in  character. 
Recently  it  has  been  introduced  into  Europe  and  also  into  this 
country,  where  it  is  made  of  cows'  milk.  It  is  a  palatable, 
nutritious  stimulant,  and  is  often  very  useful  as  a  dietetic  article 
in  disease. 

Kefyr  is  a  product  of  the  fermentation  of  milk  which  bears 
some  resemblance  to  kumys.  The  following  table  (Table  XVI) 
gives  a  comparative  view  of  the  composition  of  true  kumys,  the 
same  prepared  from  cows'  milk,  and  kefyr : — 


ALKALOIDAL    BEVERAGES. 


117 


Table  XVI. 


True  Kumys 

Cows'  Milk  Kumys 

Kefyr 

(percent.). 

(percent.). 

(percent.). 

2.20 

2.35 

3.12 

Fats 

2.12 

2.07 

1.95 

1.53 

1.81 

1.62 

0.90 

0.40 

0.83 

1.72 

1.90 

2.10 

co2 

0.85 

0.80 

0.92 

THE   ALKALOIDAL   BEVERAGES. 

The  virtues  of  the  alkaloidal  beverages  depend  upon  certain 
alkaloids  which  differ  very  little  in  their  chemical  composition 
or  physiological  effects,  and  upon  certain  volatile  aromatic  con- 
stituents of  the  various  articles  used.  The  principal  articles 
employed  in  the  preparation  of  these  beverages  are  coffee,  tea, 
chocolate,  mate,  and  coca.  It  is  estimated  that  500,000,000 
people  drink  coffee,  100,000,000  tea,  50,000,000  chocolate, 
15,000,000  mate  or  Paraguay  tea,  and  10,000,000  coca.  All 
of  these  are  active  nervous  stimulants  and  retarders  of  tissue- 
waste.  They  are  all  liable  to  produce  serious  functional  dis- 
turbances of  the  nervous,  digestive,  and  circulatory  systems  if 
used  to  excess.  Anaemia,  digestive  derangements,  constipation, 
pale,  sallow  complexion,  loss  of  appetite,  disturbed  sleep,  nervous 
headaches  and  neuralgias  are  the  most  marked  of  these  effects. 

On  the  other  hand,  when  taken  in  moderate  quantity,  the 
alkaloidal  beverages  enable  the  consumer  to  withstand  cold, 
fatigue,  and  hunger;  they  promptly  remove  the  sensation  of 
hunger,  and  diffuse  a  glow  of  exhilaration  throughout  the  body. 

Coffee. — Coffee  is  the  ripe  fruit  (seed)  of  the  Caffea  Arabica, 
a  native  of  Arabia  and  Eastern  Africa,  but  now  cultivated  in 
other  tropical  regions  of  the  world.  The  fruit  consists  of  two 
flat-convex  beans,  the  flat  surfaces  of  which  are  apposed  to  each 
other.  These  are  enclosed  in  a  fibrous  envelope  which  is  some- 
times used  as  a  cheap  substitute  for  the  coffee-bean. 

The  beverage,   coffee,  is  an  infusion  of  the  roasted  and 


118  TEXT-BOOK    OF    HYGIENE. 

ground  bean  in  hot  water.  Its  virtues  depend  upon  the  alkaloid, 
caffein,  and  an  aromatic  oil.  The  latter,  being  volatile,  is  driven 
off  by  long-continued  heat.  Hence  boiled  coffee  lacks  the 
grateful  aroma  of  that  which  is  made  by  simply  infusing  the 
ground  bean  in  hot  water. 

The  great  demand  for  coffee  and  its  comparatively  high 
price  have  caused  it  to  be  extensively  adulterated  and  substituted 
by  other  natural  and  artificial  products.  Artificial  coffee-beans 
have  been  made  of  clay,  dough,  or  extract  of  chicory,  colored 
to  imitate  the  natural  bean.  The  fraud  is  easily  detected  by 
placing  the  beans  in  water,  when  the  artificial  product  soon  falls 
to  pieces,  while  the  natural  beans  undergo  no  change  of  shape 
or  consistence. 

Ground  coffee  as  found  in  the  stores  is  usually  adulterated. 
The  materials  used  for  sophistication  are :  The  grounds  of  coffee 
previously  used,  the  roasted  root  of  chicory,  acorns,  rye  or  barley, 
carrots,  sunflower-seeds,  caramel,  and  a  number  of  articles  of 
similar  value,  generally  harmless. 

Tea. — The  plants  which  furnish  the  tea-leaves  are  natives 
of  China,  Indo-China,  and  Japan.  The  tea-leaves  contain  a 
crystalline  alkaloid,  thein,  identical  in  composition  and  proper- 
ties with  caffein.  The  various  sorts  of  tea  found  in  the  market 
(green  and  black  teas,  etc.)  differ  only  in  the  relative  proportion 
of  tannin  and  thein  contained  in  each.  The  aromatic  principle 
also  varies  somewhat  in  the  different  sorts. 

Tea  is  adulterated  to  quite  as  great  an  extent  as  coffee,  the 
leaves  of  various  plants  bearing  more  or  less  resemblance  to  tea- 
leaves  being  added  to  the  latter.  Much  of  the  tea  found  in  the 
market  is  colored  artificially  with  Prussian  blue  and  iron  oxide. 
These  additions  are  harmless,  as  they  are  not  soluble  in  water. 

Chocolate. — Cocoa,  from  which  chocolate  is  derived,  is 
widely  different  in  composition  from  tea  and  coffee.  In  addi- 
tion to  its  active  principle,  theobromin,  which  is  identical  with 
caffein  and  thein,  it  contains  nearly  50  per  cent,  of  fat,  which 
renders  it  an  article  of  high  nutritive  value. 


TOBACCO.  119 

Mate,  or  Paraguay  tea,  guarana,  and  coca  are  used  to  a 
considerable  extent  in  some  parts  of  South  America  as  substi- 
tutes for  coffee  and  tea.  Their  composition  is  not  well  known, 
but  their  effects  are  believed  to  depend  upon  alkaloidal  princi- 
ples similar  to  caffein  and  thein. 

TOBACCO. 

i 
Closely  connected  with  the  subjects  treated  in  this  chapter 
are  the  effects  of  the  constant  use  of  tobacco  upon  the  human 
system  The  depressing  effects  of  tobacco,  due  principally  to 
the  nicotine  upon  the  nervous  and  digestive  systems,  have  long 
been  recognized.  Recently,  however,  it  has  been  found  that 
very  serious  symptoms  are  produced  upon  the  sense  of  vision  by 
the  constant  or  excessive  use  of  tobacco.  A  special  form  of 
amaurosis,  termed  tobacco  amaurosis,  has  been  frequently  noticed 
since  attention  was  first  called  to  it  by  Mackenzie. 

[The  following  additional  works  are  recommended  to  the 
student : — 

Thos.  K.  Chambers,  on  Diet  in  Health  and  Disease. — Edward  Smith, 
on  Foods. — Forster,  Ernahrung,  in  Pettenkofer  u.  Ziemssen's  Handbuch 
der  Hygiene. — Munk  und  TJffelmann,  Die  Ernahrung  des  Gesunden  und 
Kranken  Menschen.] 


CHAPTER  IV. 

Soil. 

Hippocrates  treated  at  length,  in  one  of  his  works,  of  the 
sanitary  influences  of  the  soil.  Others  of  the  older  writers, 
especially  Herodotus  and  Galen,  called  attention  to  the  same 
subject,  and  Vitruvius,  the  celebrated  Roman  architect,  who 
flourished  about  the  beginning  of  the  Christian  era,  taught  that 
a  point  of  first  importance  in  building  a  dwelling  was  to  select  a 
site  upon  a  healthy  soil. 

From  this  time  until  the  beginning  of  the  eighteenth  cen- 
tury, very  little  of  value  is  found  in  medical  literature  bearing 
upon  this  subject.  In  1717,  however,  Lancisi  published  his 
great  work  on  the  causes  of  malarial  fevers,  in  which  he  laid 
the  foundation  for  the  modern  theory  of  malaria,  and  pointed 
out  the  relations  existing  between  marshes  and  low-lying  lands 
and  those  diseases  by  common  consent  called  malarial.  Other 
authors  of  the  eighteenth  and  the  early  part  of  the  nineteenth 
centuries  refer  to  the  connection  between  the  soil  and  disease, 
but  exact  investigations  have  only  been  made  within  the  last 
thirty  years. 

When  it  is  considered  that  the  air  that  human  beings 
breathe,"  and  much  of  the  water  they  drink,  are  influenced  in 
their  composition  by  the  matters  in  the  soil,  the  great  importance 
of  possessing  a  thorough  knowledge  of  the  physical  and  chemical 
conditions  of  the  soil  becomes  evident  to  every  one. 

PHYSICAL   AND    CHEMICAL    CHARACTERS   OF   THE    SOIL. 

In  the  hygienic,  as  in  the  geological  sense,  rock,  sand,  clay, 
and  gravel  are  included  in  the  consideration  of  soils. 

The  soil,  as  it  is  presented  to  us  at  the  surface  of  the  earth, 


122  TEXT-BOOK   OF    HYGIENE. 

is  the  result  of  long  ages  of  disintegration  of  the  primitive 
rocks  by  the  action  of  the  elements,  of  the  decomposition  of 
organic  remains,  and,  possibly,  of  accretions  of  cosmical  dust. 
The  principal  factor,  however,  is  the  action  of  water  upon  rock, 
in  leveling  the  projections  of  the  earth's  surface  produced  by 
volcanic  action. 

Soils  vary  considerably  in  physical  and  chemical  constitu- 
tion. A  soil  may,  for  example,  consist  exclusively  of  sand,  of 
clay,  or  of  disintegrated  calcareous  matter.  Other  soils  may 
consist  of  a  mixture  of  two  or  more  of  these,  together  with 
vegetable  matter  undergoing  slow  oxidation.  In  forests,  a  layer 
of  this  slowly-decomposing  vegetable  matter  of  varying  thick- 
ness is  found,  covering  the  earthy  substratum.  This  organic 
layer  is  called  humus,  and  when  turned  under  by  plough  or 
spade,  and  mixed  with  the  sand  or  clay  base,  it  constitutes  the 
ordinary  agricultural  soil. 

THE    ATMOSPHERE    OF   THE    SOIL,   OR    GROUND-AIR. 

The  interstices  of  the  soil  are  occupied  by  air  or  water,  or 
by  both  together.  The  soil's  atmosphere  is  continuous  with, 
and  resembles  in  physical  and  chemical  properties,  that  which 
envelops  the  earth.  Its  proportion  to  the  mass  of  the  soil 
depends  upon  the  degree  of  porosity  of  the  soil,  and  upon  the 
amount  of  moisture  present.  In  a  very  porous  soil,  such  as,  for 
example,  a  coarse  sand,  gravelly  loam,  or  coarse-grained  sand- 
stone, the  amount  of  air  is  much  greater  than  in  a  clayey  soil, 
granite,  or  marble.  So,  likewise,  when  the  soil  contains  a  large 
proportion  of  water,  the  air  is  to  this  extent  excluded.  The 
porosity  of  the  various  soils,  as  evidenced  by  the  amount  of  air 
contained  in  them,  is  much  greater  than  would,  at  first  thought, 
be  supposed.  Thus  it  has  been  found  that  porous  sandstone 
may  contain  as  much  as  one-third  of  its  bulk  of  air,  while  the 
proportion  of  air  contained  in  sand,  gravel,  or  loose  soil  may 
amount  to  from  30  to  50  per  cent. 

The  ground-air  is  simply  the  atmospheric  air  which  has 


THE    ATMOSPHERE   OF   THE    SOIL,    OR   GROUND-AIR.  123 

penetrated  into  the  interstices  of  the  soil  and  taken  part  in  the 
various  chemical  decompositions  going  on  there.  In  consequence 
of  these  chemical  changes  the  relative  proportions  of  the  oxygen 
and  carbonic  acid  in  the  air  are  changed — oxygen  disappearing 
and  giving  place  to  carbon  dioxide.  It  is  well  known  that 
during  the  decay  of  vegetable  matter  in  the  air  carbon  dioxide 
is  formed;  one  constituent  of  this  compound,  the  carbon,  being 
derived  from  the  vegetable  matter,  while  the  oxygen  is  taken 
from  the  air.  Hence,  if  this  action  takes  place  where  there  is 
not  a  very  free  circulation  of  air,  as  in  the  soil,  the  air  there 
present  soon  loses  its  normal  proportion  of  oxygen,  which  enters 
into  combination  with  the  carbon  of  the  vegetable  matter  to 
form  carbon  dioxide. 

Thirty  years  ago,  MM.  Boussingault  and  Levy,  two  dis- 
tinguished French  chemists,  examined  the  air  contained  in 
ordinary  agricultural  soil,  and  found  that  the  oxygen  was 
diminished  to  about  one-half  of  the  proportion  normally  present 
in  atmospheric  air,  while  the  carbon  dioxide  was  enormously 
increased.  The  exact  results  obtained  by  Boussingault  and 
Levy  were  as  follow: — 

In  100  volumes  of  ground-air  there  were  10.35  volumes 
of  oxygen,  79.91  volumes  of  nitrogen,  9.74  volumes  of  carbon 
dioxide.  In  atmospheric  air,  on  the  other  hand,  there  are  in 
100  volumes  20.9  volumes  of  oxygen,  79.1  volumes  of  nitrogen, 
0.04  volume,  or  about  ^  of  1  per  cent,  of  carbon  dioxide. 

In  spite  of  the  striking  results  obtained  by  these  two 
chemists,  very  little  attention  was  paid  to  them  by  sanitarians,  as 
very  few  seemed  to  have  any  clear  notion  of  the  relations  exist- 
ing between  the  motions  of  the  air  above-ground  and  that  under- 
ground. 

In  1871,  however,  Professor  von  Pettenkofer,  of  Munich, 
published  the  results  of  his  own  examinations  into  the  constitu- 
tion and  physical  conditions  of  the  ground-air,  and  the  relations 
of  the  latter  to  the  propagation  of  epidemic  diseases.  These  re- 
searches, which  created  a  wide-spread  interest  in  the  subject, 


124  TEXT-BOOK   OF    HYGIENE. 

were  extended  by  other  observers  in  all  parts  of  the  world. 
These  observers,  prominent  among  whom  were  Professors  Fleck, 
Fodor,  and  Soyka,  in  Germany ;  Drs.  Lewis  and  Cunningham, 
in  India  ;  Prof.  William  Ripley  Nichols,  in  Boston ;  and  Sur- 
geons J.  H.  Kidder  and  S.  H.  Griffith,  of  the  U.  S.  Navy,  in 
Washington,  demonstrated  that  the  increase  of  carbon  dioxide 
in  the  ground-air  is  due  to  increased  vegetable  decomposition 
and  to  lessened  permeability  of  the  soil.  A  permeable,  that  is 
to  say,  a  sandy  or  gravelly  soil  is  likely  to  contain  less  carbon 
dioxide  in  its  atmosphere  than  a  dense,  less  permeable  clay, 
although  the  amount  of  decomposition  going  on  and  the  pro- 
duction of  carbon  dioxide  in  the  former  may  considerably  ex- 
ceed the  latter.  In  the  loose,  sandy  soil  the  circulation  of  the 
air  is  less  obstructed,  and  the  carbon  dioxide  may  easily  escape 
and  be  diffused  in  the  superincumbent  air,  while  the  close-pored 
clay  imprisons  the  carbon  dioxide  and  prevents  or  retards  its 
escape  into  the  air  above. 

The  disappearance  of  oxygen  from  the  ground-atmosphere 
is  coincident  with  the  production  of  an  equivalent  amount  of 
carbon  dioxide.  It  appears  from  this  that  in  the  soil  an  ox- 
idation  of  carbonaceous  substances  takes  place,  the  product  of 
which  is  found  in  the  excess  of  carbon  dioxide  in  the  ground-air. 

Professor  Nichols  has  found  the  proportion  of  carbon  di- 
oxide in  the  air  taken  from  a  depth  of  3  metres  below  the 
surface  in  the  "made-land"  of  Boston  to  amount  to  21.21  per 
thousand,  the  observation  having  been  made  in  August.  In 
December,  at  a  depth  of  2  metres,  the  proportion  was  3.23  per 
thousand.  Fodor,  in  Buda-Pesth,  found  the  proportion  of  carbon 
dioxide  to  be  107.5  per  thousand  (over  10  per  cent.),  the  air 
having  been  taken  from  a  depth  of  3  metres. 

The  ground-air  also  teems  with  micro-organisms  of  various 
kinds,  these  being  occasionally  pathogenic.  While  in  the  great 
majority  of  instances  the  micro-organisms  found  are  ordinary 
mold  or  fermentation  fungi  and  bacteria  of  decay  and  putrefac- 
tion, disease-producing  bacilli   have  also  been   observed  in  a 


THE    ATMOSPHERE   OF    THE    SOIL,    OR    GROUND-AIR.  125 

number  of  instances.  Among  the  latter  are  the  bacillus  of 
tetanus  (Nicolaier),  of  anthrax  (Frank),  of  malaria  (Klebs  and 
Tommasi-Crudeli),1  of  malignant  oedema  (Koch  and  Gaffky), 
and  of  typhoid  fever  (Tryde). 

It  may  not  be  inappropriate  to  refer  here  to  the  claim  of 
Professor  Domingos  Freire,  of  Brazil,  to  the  discovery  of  the 
germ  of  yellow  fever  in  the  soil  of  a  burial  ground  near  Rio 
Janeiro.  The  exhaustive  investigations  of  Dr.  G.  M.  Sternberg, 
of  the  U.  S.  Army,  under  the  direction  of  the  government,  have 
disposed  effectually  of  the  claims  and  pretensions  of  the  Brazilian . 
scientist,  and  established  the  fact  that  Freire's  organism  has  no 
pathological  significance  whatever, — at  all  events,  that  it  has  no 
relation  to  yellow  fever. 

Cholera  bacilli  have  not  been  found  in  the  soil,  but  C. 
Frankel  has  shown  experimentally  that  they  can  grow  and 
multiply  in  the  soil  at  various  depths.  At  a  depth  of  1^ 
metres  their  development  was  constant  and  progressive 
throughout  the  year. 

When  the  soil  is  dry,  these  organisms  may  be  carried  hither 
and  thither  in  the  movements  of  the  ground-air,  and  thus  infect 
the  air  of  contiguous  localities,  or  be  transported  to  a  distance. 

Movements  of  the  ground-atmosphere  are  principally  due 
to  differences  of  pressure  and  temperature  in  the  air  above- 
ground.  Owing  to  such  differences  the  air  from  the  soil  fre- 
quently permeates  houses,  entering  from  cellars  or  basements. 
In  winter,  when  the  air  of  houses  is  very  much  more  heated 
(and  consequently  less  dense)  than  the  air  out-of-doors, 
the  difference  of  pressure  thus  caused  draws  the  ground-air  up 
through  the  house,  while  the  cold,  external  atmosphere  pene- 
trates the  soil  and  occupies  the  place  of  the  displaced  ground- 
air.2     A  similar  effect   occurs  in   consequence  of  heavy  rains. 

1  While  the  pathogenic  significance  of  Klehs'  bacillus  malaria;  is  not  generally  accepted, 
it  is  thought  proper,  for  the  sake  of  completeness,  to  include  it  among  the  organisms  sometimes 
found  in  the  soil. 

11  It  is,  of  course,  not  strictly  correct  to  say  that  the  air  is  drawn  up  through  the  house 
by  the  diminution  of  pressure;  it  being  rather  forced  out  of  the  soil  by  the  colder  and  denser 
outside  air ;  but  the  phrase  is  sufficiently  exact  and  will  be  readily  understood. 


126  TEXT-BOOK   OF   HYGIENE. 

The  water  fills  up  the  interstices  of  the  soil  near  the  surface,  and 
forces  the  ground-air  out  at  points  where  the  pores  remain  open. 
These  places  are  the  dry  ground  under  buildings,  where  the  air 
escapes  and  passes  through  floors  and  ceilings  into  the  house 
above.  Heavy  rains  may  thus  be  the  cause  of  pollution  of  the 
air  in  houses.  The  greater  the  porosity  of  the  soil,  the  more 
likely  is  this  to  happen.  This  pollution  of  the  house-air  may 
be  prevented  by  having  impervious  floors  and  walls  to  cellars 
and  basements,  or  by  interposing  a  layer  of  charcoal  between 
the  ground  and  the  floor  of  the  house.  The  latter  does  not 
prevent  the  passage  of  the  ground-air,  but  the  charcoal  layer 
absorbs  or  arrests  the  noxious  matters, — filters  the  ground-air, 
as  it  were. 

In  the  spring  and  early  summer  the  ground  being  colder 
than  the  air  above  it,  and  the  ground-air  consequently  heavier 
and  denser,  the  latter  is  not  easily  displaced.  It  is,  perhaps, 
due  to  this  fact  that  those  infectious  diseases  which  are  proba- 
bly dependent  upon  the  movements  of  the  ground-air  are  less 
prevalent  in  the  spring  and  early  summer  than  in  the  latter 
part  of  the  summer,  autumn,  and  early  winter.  In  the  autumn 
the  ground-air  being  warmer  than  the  air  above  ground  is  easily 
displaced  by  the  latter  and  forced  out  into  the  streets  and  houses 
to  be  inspired  by  men  and  animals.  The  same  conditions  may 
explain  the  greater  likelihood  of  infection  at  night,  which  is 
proven  fot  such  diseases  as  malarial  and  yellow  fevers.  The 
colder  outside  air  penetrates  the  interstices  of  the  soil  and  forces 
out  the  impure  ground-air. 

The  researches  of  Fodor  have  demonstrated  that  the  pro- 
portion of  carbon  dioxide  in  the  ground-air  may  be  taken  as  an 
approximative  measure  of  the  impurity  of  the  soiL  whence  the 
air  is  taken.  The  influence  of  the  permeability  of  the  soil,  as 
before  pointed  out,  must,  however,  not  be  overlooked  in  esti- 
mating the  signification  of  the  carbon  dioxide.  Fodor  has 
shown  that  the  proportion  of  carbon  dioxide  in  the  ground-air, 
and   consequently   the   amount   of  organic    decomposition,   is 


THE    ATMOSPHERE    OF   THE    SOIL,    OR    GROUND- AIR.  127 

greatest  in  July  and  least  in  March.  That  the  carbon  dioxide 
is  derived  from  the  decomposition  of  vegetable  matter  has  been 
proven  by  Pettenkofer.  This  observer  examined  specimens  of 
air  brought  from  the  Lybian  desert,  and  found  that  the  propor- 
tion of  carbon  dioxide  in  the  ground-air  was  exactly  the  same 
as  in  the  air  collected  above-ground.  There  being  no  vegetable 
growth  in  the  desert  there  can,  of  course,  be  no  vegetable 
decomposition  going  on  in  the  soil. 

The  excess  of  carbon  dioxide  in  the  ground-air  is  an  indi- 
cation of  the  deficiency  of  oxygen,  as  has  been  shown.  The 
air  at  a  depth  of  4  metres  below  the  surface  was  found  to 
contain  only  from  7  to  10  per  cent,  of  oxygen — one-half  to  one- 
third  of  the  normal  proportion.  Many  basements  occupied  by 
people  as  living-rooms  extend  from  1  to  3  metres  under-ground, 
and  hence  are  liable  to  be  supplied  with  an  atmosphere  approach- 
ing in  impurity  that  just  mentioned.  It  requires  no  very  vivid 
imagination  to  appreciate  the  dangers  to  health  that  lurk  in  such 
habitations. 

THE   WATER    OF    THE    SOIL,    OR   GROUND-WATER. 

At  a  variable  depth  below  the  surface  of  the  ground,  a 
stratum  of  earth  or  rock  is  found  through  which  water  passes 
with  difficulty,  if  at  all.  Above  this  there  is  a  stratum  of  water 
which  moves  from  a  higher  to  a  lower  level,  and  which  varies 
in  depth  at  different  times  according  to  the  amount  of  precipita- 
tion (rain-  or  snow-  fall),  and  according  to  the  level  of  the  nearest 
body  of  water  toward  which  it  flows.  This  stratum  of  water 
is  termed  the  ground-ivater,  and  has  within  the  last  few  years 
assumed  considerable  importance  from  its  apparently  close  rela- 
tions to  the  spread  of  certain  of  the  infectious  diseases.  The 
direction  of  horizontal  flow  of  ground-water  is  always  toward 
the  drainage-area  of  the  district.  Thus,  it  is  usually  toward 
lakes,  rivers,  or  the  sea.  Rains,  or  a  rise  in  the  river,  cause  a 
rise  in  the  ground-water,  while  long-continued  dry  weather,  or 
a  low  stage  of  the  river  which  drains  off  the  ground- water, 


128  TEXT-BOOK   OF   HYGIENE. 

causes  a  fall  in  the  latter.  On  the  sea-coast  the  ground-water 
oscillations  probably  correspond  with  the  tides.  The  writer  is 
not  aware  of  any  observations  made  to  determine  this  point, 
with  the  exception  of  a  single  instance  mentioned  by  Dr.  De 
Chaumont.  In  Munich,  where  the  ground-water  flows  toward 
the  river  Isar,  which  divides  the  city,  it  has  been  found  that  the 
annual  range  or  oscillation  (the  difference  between  the  highest 
and  lowest  level  during  the  year)  is  3  metres,  while  the  hori- 
zontal movement  amounts  to  5  metres  per  day.  In  Buda-Pesth 
the  annual  range  was  found  by  Fodor  to  be  less  than  1  metre, 
while  in  some  portions  of  India  it  amounts  to  more  than  12 
metres.  As  it  is  from  the  ground-water  that  the  greater  portion 
of  the  supply  of  drinking-water  in  the  country  and  in  villages 
and  small  towns  is  drawn,  it  becomes  at  once  manifest  how 
important  it  is  to  prevent,  as  far  as  possible,  pollution  of  this 
source.  Cess-pools  and  manure-heaps  and  pits,  of  necessity, 
contaminate  the  soil  and  also  ground-water  for  a  distance  below 
and  around  them,  and  such  wa.ter  is  clearly  unfit  for  drinking 
and  other  domestic  purposes.  Hence,  the  reason  why  wells 
should  not  be  placed  too  near  privies  and  manure-heaps  or  pits 
becomes  apparent. 

Between  the  level  of  the  ground-water,  or  that  portion  of 
the  soil  where  its  pores  are  entirely  occupied  by  the  water — 
where,  in  other  words,  the  ground  is  saturated — and  the  surface, 
is  a  stratum  of  earth  more  or  less  moist ;  that  is  to  say,  the 
interstices  of  the  soil  are  partly  filled  with  water  and  partly  with 
air.  It  is  in  this  stratum  that  the  processes  of  organic  decay  or 
putrefaction  are  most  rapidly  going  on,  in  consequence  of  which 
the  pollution  of  the  ground-air  occurs.  The  oxidation  of  non- 
nitrogenous  matter  in  the  soil  results  in  the  formation  of  carbon 
dioxide.  On  the  other  hand,  nitrogenized  compounds  are 
oxidized  into  nitric  acid  and  nitrates.  When,  however,  putre- 
faction occurs,  nitrous  acid,  or  nitrites  and  ammonia,  are  formed, 
the  oxidation  not  proceeding  far  enough  to  result  in  nitric  acid. 

Recent  observations  seem  to  show  that  these  processes  of 


THE    WATER    OF    THE    SOIL.    OR    GROUND- WATER.  129 

decomposition  are  initiated  and  kept  up  by  minute  organisms 
termed  bacteria,  just  as  fermentation  in  liquids  containing  sugar 
can  only  take  place  in  the  presence  of  the  yeast-plant.  It  has; 
been  found  that  when  non-putrefactive  decomposition  goes  onv 
there"  are  always  present  multitudes  of  one  variety  of  these 
minute  organisms;  while  if  putrefactive  decomposition  is  going 
on,  a  number  of  other  varieties  of  these  organisms  are  present. 
Just  as,  when  a  fermenting  liquid  becomes  putrid,  the  yeast-plant 
disappears  and  its  place  is  taken  by  the  ordinary  bacteria  of  putre- 
faction, so  in  the  soil,  if  the  access  of  oxygen,  which  is  necessary 
to  the  life  of  the  bacteria  of  decay,  is  prevented,  these  organisms 
die  and  are  succeeded  by  the  organisms  of  putrefaction.  It  has 
been  found  that  in  a  soil  saturated  with  water  the  bacteria  of  decay 
cannot  live,  while  those  of  putrefaction  may  flourish,  because 
these  latter  organisms  can  sustain  life  and  develop  in  the 
absence  of  oxygen.  Professor  Fodor's  researches  indicate  that 
the  most  prominent  organism  of  non-putrefactive  decomposition 
or  decay  is  that  which  is  termed  by  Cohn  bacterium  lineola ;  and 
that  the  bacterium  termo  is  the  principal  organism  of  putrefaction. 

DISEASES    SPREAD    BY    SOIL    IMPURITIES. 

Given  now  an  area  of  soil,  say  the  ground  upon  which  a 
house  or  city  is  built,  with  a  moist  stratum  in  which  the  pro- 
cesses of  decay  are  active,  and  imagine  a  rise  in  the  ground- 
water. The  ground-air,  charged  with  carbon  dioxide  and  other 
products  of  decomposition,  is  forced  out  of  the  pores  of  the  soil 
by  the  rising  ground-water,  and  escapes  into  the  external  air, 
or  through  cellars  and  basements  into  houses,  and  may  there 
produce  disease.  But  the  saturation  of  the  soil  with  water  pre- 
vents the  further  development  of  the  bacteria  of  decay,  and  this  is 
checked,  or  putrefaction  may  take  place.  If  now  the  ground- 
water sinks  to  its  former  level  or  below,  the  processes  of  decay 
again  become  very  active  in  the  moist  stratum,  and  large  quan- 
tities of  carbon  dioxide  and  other  inorganic  compounds  are 
produced.     If  the  germs  of  infectious  or  contagious  diseases 


130  TEXT-BOOK   OF   HYGIENE. 

have  been  introduced  into  the  soil,  they  also  multiply  and  may 
escape  with  the  movements  of  the  ground-air  into  the  external 
atmosphere,  and  there  produce  their  infective  action.  This,  it  is 
held  by  Pettenkofer  and  his  followers,  is  what  actually  occurs  in 
cholera  and  typhoid  fever.  Professor  DeChaumont  has  laid 
down  the  rule  that  a  soil  with  a  persistently  low  stage  of  ground- 
water, say  5  metres  below  the  surface  of  the  ground,  is  healthy; 
a  persistently  high  stage  of  ground- water,  less  than  1|-  metres 
below  the  surface,  is  unhealthy;  while  a  fluctuating  level  of  the 
ground-water,  especially  if  the  changes  are  sudden  and  violent, 
is  very  unhealthy.  This  would  lead  us  to  expect  that  places 
where  this  fluctuation  is  very  great  would  show  a  large  mortality 
from  such  diseases  as  are  attributed  to  impurities  in  the  soil. 
And  this  we  find  especially  true  in  India.  In  certain  localities 
in  India,  cholera,  for  example,  is  endemic ;  that  is  to  say,  the 
disease  is  never  entirely  absent  in  such  localities.  Calcutta  is 
one  of  these  places.  The  rainy  season  begins  about  the  first  of 
May  and  continues  until  the  end  of  October.  During  the  next 
six  months  there  is  very  little  rain.  It  is  fair  to  assume  that 
the  ground- water  rises  during  the  rainy  season  and  checks  decay 
and  the  multiplication  of  the  germs  of  the  disease  in  the  soil, 
and  that  these  processes  become  more  active  as  the  dry  season 
advances  and  the  ground-water  level  falls.  If  we  note  the 
death-rate  from  cholera  in  Calcutta  it  will  be  found  that  it  bears 
a  distinct  relation  to  the  movement  of  the  ground-water.  The 
deaths  from  cholera  begin  to  increase  from  October  and  reach 
their  height  in  April.  Dr.  Macpherson,  who  has  written  a  very 
elaborate  history  of  Asiatic  cholera,  shows  this  relation  very 
clearly.  For  twenty-six  years  the  average  rain-fall  was  157  cen- 
timetres. From  May  to  October  1 42  centimetres  fell,  while  the 
remaining  15  centimetres  fell  from  November  to  April.  The 
average  number  of  deaths  from  cholera  annually  was  4013. 
Of  these,  1238  died  in  the  rainy  season,  while  2775,  nearly 
three-fourths,  died  during  the  period  of  dry  weather. 

In  the  cholera  epidemics  of  1866  and  1873  in  Buda-Pesth, 


DISEASES    SPREAD    BY    SOIL    IMPURITIES.  131 

the  same  relations  existed  between  the  ground-water  and  the 
cholera.  As  the  level  of  the  ground-water  rose  the  cholera 
diminished,  while  the  disease  increased  upon  the  sinking  of  the 
ground-water.  Exactly  the  same  behavior  was  exhibited  by  the 
disease  in  Munich  in  1873. 

There  seems  good  reason  to  believe  that  typhoid  fever  is 
propagated  in  consequence  of  movements  of  the  ground-water, 
in  the  same  way  as  above  explained  for  cholera.  This  does  not 
exclude  the  infection  of  drinking-water  by  the  disease-germ, 
since  much  of  the  drinking-water  used,  as  before  stated,  is  drawn 
from  the  ground-water.  Pettenkofer,  Buhl,  and  Virchow  have 
shown  that  the  death-rate  from  typhoid  fever  has  a  distinct  and 
definite  relation  to  the  ground-water  oscillations.  This  has  been 
incontestably  proven  for  two  cities,  Munich  and  Berlin.  When 
the  level  of  the  ground- water  is  above  the  average,  typhoid  fever 
decreases;  when  it  is  below  the  average,  the  number  of  cases 
becomes  greater.  Dr.  H.  B.  Baker  has  demonstrated  that  the 
fluctuation  of  the  ground-water  level  in  the  State  of  Michigan 
is  similarly  followed  by  a  change  in  the  morbility  and  mortality 
from  typhoid  fever.1  Hence,  it  may  be  regarded  as  an  established 
law  that  the  rise  and  fall  of  the  ground-water  bears  a  definite 
relation  to  the  morbility  rate  of  typhoid  fever. 

Nearly  thirty  years  ago  Dr.  Henry  I.  Bowditch,  of  Boston, 
called  attention  to  the  frequent  connection  between  cases  of 
pulmonary  consumption  and  dampness  of  the  soil  upon  which 
the  patients  lived.  After  a  very  extended  and  laborious  investi- 
gation Dr.  Bowditch  formulated  these  two  propositions: — 

"  First. — A  residence  in  or  near  a  damp  soil,  whether  that 
dampness  be  inherent  in  the  soil  itself  or  caused  by  percolation 
from  adjacent  ponds,  rivers,  meadows,  or  springy  soils,  is  one  of 
the  principal  causes  of  consumption  in  Massachusetts,  probably 
in  New  England,  and  possibly  other  portions  of  the  globe. 

"  Second. — Consumption  can  be  checked  in  its  career,  and 

1  The  Relation  of  the  Depth  of  Water  in  Wells  to  the  Causation  of  Typhoid  Fever, 
Public  Health,  vol.  x,  p.  184-213. 


132  TEXT-BOOK   OF    HYGIENE. 

possibly — nay,  probably — prevented  in  some  instances  by  atten- 
tion to  this  law."1 

Dr.  Buchanan,  of  England,  about  the  same  time  showed 
that  the  thorough  drainage  of  certain  English  cities  had  mark- 
edly diminished  the  deaths  from  consumption  in  the  drained 
cities.  So  far  as  the  writer  is  aware,  not  a  single  fact  has  been 
established  which  militates  against  the  law  laid  down  by  Dr. 
Bowditch,  and  so  strongly  supported  by  the  statistical  researches 
of  Dr.  Buchanan,  yet  hardly  any  notice  has  been  taken  of  these 
results  by  physicians.  Few  know  anything  of  them,  and  still 
fewer  seem  to  have  made  practical  use  of  such  knowledge  in 
advising  patients.  As  corroborative  of  the  views  of  Dr.  Bow- 
ditch,  the  rarity  of  consumption  in  high  and  dry  mountainous 
districts  or  plateaus  may  be  cited. 

A  recent  study  of  the  topographical  distribution  of  con- 
sumption in  the  State  of  Pennsylvania,  by  Dr.  William  Pepper, 
apparently  confirms  Dr.  Bowditch's  conclusions  in  nearly  every 
particular.  It  is  now  known  that  the  direct  cause  of  consump- 
tion is  the  bacillus  tuberculosis,  discovered  by  Dr.  Robert  Koch. 
The  relation  between  soil-moisture  and  the  increase  of  consump- 
tion will  probably  be  found  in  the  more  favorable  conditions 
of  development  of  the  tubercle  bacillus  furnished  by  a  moist 
medium. 

DISEASES    OF    ANIMALS    PROBABLY   DUE   TO    SIMILAR    CONDITIONS    OF 

THE    SOIL. 

The  modern  study  of  the  sanitary  relations  of  the  soil  is 
still  in  its  infancy.  Whatever  definite  knowledge  has  been 
gained  relates  merely  to  physical  or  chemical  conditions  of  the 
soil  and  its  atmosphere  and  moisture,  or  possibly  the  relations 
of  these  to  the  spread  of  certain  diseases  in  human  beings.  But 
there  is,  perhaps,  a  wider  application  that  may  be  made  of  such 
knowledge  than  has  been  heretofore  suggested.  The  domestic 
animals  which  form  such  a  large  portion  of  the  wealth  of  this 

1  Consumption  in  New  England  and  Elsewhere.  2d  ed.,  p.  87.    Boston,  1866. 


DISEASES  OF  ANIMALS  DUE  TO  SIMILATt  CONDITIONS  OF  SOIL.       133 

country — horses,  cattle,  sheep,  and  hogs — are  liable  to  infectious 
and  contagious  diseases,  as  well  as  are  human  beings,  and  many 
millions  of  dollars  are  lost  annually  by  the  ravages  of  such 
diseases.  Now,  from  what  is  known  of  such  diseases  as  splenic 
fever  among  cattle,  and  of  the  so-called  siuine  plague,  it  does 
not  appear  improbable  to  the  writer  that  the  source  of  infection 
is  a  soil  polluted  by  the  poisonous  germ  of  these  diseases,  just 
as  it  seems  demonstrated  that  cholera  and  typhoid  fever  and 
possibly  malarial  fevers  are  so  caused.  The  laborious  investiga- 
tions of  M.  Pasteur  in  France  have  shown  that  the  cause  of 
splenic  fever,  when  once  introduced  into  a  locality,  will  remain 
active  for  months,  and  even  years,  and  it  seems  probable  that  a 
study  of  the  soil  in  its  relations  to  the  diseases  of  domestic 
animals  is  a  subject  to  which  attention  may  profitably  be 
given. 

It  is  well  known  that  milch-cows  frequently  suffer  from  a 
disease  identical  in  its  nature  with  consumption  in  human 
beings.  It  is  believed  by  many  that  the  milk  of  such  animals 
is  not  only  unfit  for  food  by  reason  of  its  poor  quality,  but  that 
it  may  convey  the  disease  to  human  beings  when  used  as  food. 
The  observations  of  Bowditchand  Buchanan,  quoted  above, 
show  that  consumption  in  man  may  be,  and  doubtless  is, 
frequently  caused  by  soil-wetness.  It  seems  probable  that  the 
same  cause  should  produce  similar  effects  in  the  lower  animals, 
and  it  is  the  writer's  firm  conviction  that  an  examination  into 
the  circumstances  under  which  cows  become  attacked  by  con- 
sumption would  prove  this  probability  a  fact. 

DEAINAGE. 

In  many  soils  drainage  is  necessary  in  order  to  secure  a 
constant  level  of  the  ground-water  at  a  sufficient  depth  below 
the  surface.  Drainage  and  sewerage  must  not  be  confounded 
with  each  other.  Drainage  contemplates  only  the  removal  of 
the  ground-water,  or  the  reduction  of  its  level,  while  sewerage 
aims  to  remove  the  refuse  from  dwellings  and  manufactories, 


134  TEXT-BOOK   OF   HYGIENE. 

including  excrementitious  matters,  waste-water,  and  other 
products,  and  in  some  cases  the  storm-water. 

Sewers  should  never  be  used  as  drains,  although  for 
economy's  sake  sewer-  and  drainage-  pipes  may  be  laid  in  the 
same  trench.  Sewer-pipe  must  be  perfectly  air-tight  and  water- 
tight to  prevent  escape  of  its  liquid  or  gaseous  contents  into  the 
surrounding  soil  and  rendering  it  impure.  Drainage-pipe,  on 
the  other  hand,  should  be  porous  and  admit  water  freely  from 
without.  Escape  of  the  contents  of  the  drain-pipe  into  the 
surrounding  soil  will  not  produce  any  pollution  of  the  latter. 

The  best  material  for  drains  is  porous  earthenware  pipe,  or 
the  ordinary  agricultural  drain-tile.  Coarse  gravel  or  broken 
stones  may  also  be  used,  and  prove  efficient  if  the  drains  are 
properly  constructed.  Referring  again  to  the  aphorism  of 
Professor  DeChaumont,  that  a  persistently  low  ground-water, 
say  5  metres  down,  or  more,  is  healthy;  that  a  persistently  high 
ground-water,  less  than  1|  metres  from  the  surface  is  unhealthy; 
and  that  a  fluctuating  level,  especially  if  the  changes  are  sudden 
and  violent,  is  very  unhealthy,  the  necessity  appears  obvious 
that  in  the  construction  of  drainage-works  the  drains  should  be 
placed  at  a  sufficient  depth  to  secure  a  level  of  the  ground-water 
consistent  with  health.  This  depth  should  never  be  less  than 
3  metres,  and,  if  possible,  not  less  than  5  metres.  Care  must  be 
taken  that  the  outflow  of  the  drain  is  unobstructed,  in  order 
that  the  soil  may  be  kept  properly  dry  at  all  times. 

In  the  absence  of  a  proper  mechanical  system  of  drainage, 
the  planting  of  certain  trees  may  efficiently  drain  the  soil.  It 
has  been  found  that  the  eucalyptus  tree  has  produced  drying  of 
the  soil  when  planted  in  sufficient  numbers  in  marshy  land. 
The  roots  absorb  a  prodigious  quantity  of  water,  which  is  then 
given  off  by  evaporation  from  the  leaves.  Sunflower-plants  have 
a  similar  effect  upon,  wet  soils. 


CHAPTER  V. 

Removal  of  Sewage. 

In  all  larger  communities  certain  arrangements  are  neces- 
sary to  secure  a  prompt  and  efficient  removal  of  excreta  and 
the  refuse  and  used  water  of  households  and  manufacturing 
establishments,  the  sweepings  of  streets,  and  rain-water. 

The  total  quantity  of  excrementitious  products — faeces  and 
urine — for  each  individual,  including  men,  women,  and  children, 
has  been  estimated  by  Professor  von  Pettenkofer  as  90  grammes 
of  faecal  and  1170  grammes  of  urinary  discharge  daily.  This 
would  give  for  a  population  of  1000  persons  34,000  kilogrammes 
of  faeces  and  428,000  litres  of  urine  per  year.  If  to  this  is 
added  a  minimum  allowance  of  159  litres  of  water  per  day  to 
each  individual,  a  complete  sewerage  system  for  a  population 
of  1000  persons  would  require  provision  for  the  discharge  of 
160,000  litres  of  sewage  passing  through  the  sewers  every  clay. 
In  this  estimate  storm- water  and  such  accessory  feeders  of  the 
sewage  are  omitted. 

The  organic  matters  contained  in  sewage,  even  if  free  from 
the  specific  germs  of  disease,  give  rise  to  noxious  emanations, 
which,  when  inhaled,  probably  produce  a  gradual  depravement 
of  nutrition  that  renders  the  system  an  easier  prey  to  disease. 
For  this  and  other  reasons  it  is  important  that  such  measures  be 
adopted  as  will  secure  the  removal  of  sewage  matters  from  the 
immediate  vicinage  of  houses  as  quickly  as  possible  after  they 
have  been  discharged. 

The  impregnation  of  the  soil  with  sewage  produces  a  con- 
tamination of  ground-air  and  ground-water,  which  may  become 
a  source  of  grave  danger  to  health.  By  polluting  the  ground- 
water it  eventually  vitiates  the  well-water,  which  is  nearly  always 
derived  from  that  source. 

(135) 


136  TEXT-BOOK    OF    HYGIENE. 

The  system  of  removal  of  excrementitious  matters  which 
any  community  will  adopt  depends  to  a  considerable  extent  upon 
financial  considerations.  Although  the  sanitarian  must  insist 
upon  the  pre-eminent  importance  of  the  cause  of  public  health, 
his  suggestions  will  receive  little  attention  from  municipal  or 
state  legislatures  unless  they  can  be  carried  out  without  involv- 
ing the  community  too  deeply  in  debt.  For  this  reason  it  is  a 
matter  of  great  practical  importance  that  the  student  of  sani- 
tary science  should  make  himself  familiar  with  the  relative  cost 
as  well  as  with  the  hygienic  significance  of  the  various  methods 
of  sewage  removal  in  use. 

The  different  systems  in  use  for  the  removal  of  sewage 
matters  may  be  considered  in  detail  under  the  following  five 
heads : — 

1.  The  common  privy,  or  privy- vault  systems. 

2.  The  Rochdale  or  pail  system,  and  its  modifications. 

3.  The  earth-  or  ash-  closet  system. 

4.  The  pneumatic  system  of  Liernur. 

5.  The  water-carriage  systems. 

1.  The  Privy  and  Privy-well  Systems. — While  from  a 
sanitary  point  of  view  privies  of  all  kinds,  whether  wells  or 
cess-pits,  are  to  be  unreservedly  condemned,  it  is  not  likely  that 
they  will  cease  to  be  built  for  many  years  to  come.  It  becomes 
necessary,  therefore,  to  point  out  by  what  means  the  objections 
against  them  may  be  diminished,  and  their  evil  consequences  in 
some  measure  averted. 

In  the  first  place,  a  privy- vault  should  be  perfectly  water- 
tight in  order  to  prevent  pollution  of  the  surrounding  soil  by 
transudation  of  the  contained  excremental  matters.  The  walls 
should  be  of  hard-burned  brick  laid  in  cement.  The  cavity 
should  be  small  in  order  that  the  contents  may  be  frequently  re- 
moved, and  not  allowed  to  remain  and  putrefy  for  months  or 
years.  A  water-tight  hogshead  sunk  in  the  ground  makes  an 
economical  privy-tank  or  receiver.  A  privy  must  not  be  dug  in 
a  cellar,  or  in   too  close  proximity  to  the  house-walls.     Unless 


REMOVAL    OF    SEWAGE.  137 

these  last  precautions  are  taken  the  offensive  gases  from  the 
mass  of  decomposing  faecal  matter  in  the  privy  will  constantly 
ascend  into  and  permeate  the  air  of  the  house. 

All  privies  should  be  ventilated  by  a  pipe  passing  from  just 
under  the  privy-seat  to  a  height  of  about  a  metre  above  the 
roof  of  the  house.  A  gas-flame,  kept  burning  in  the  upper  portion 
of  this  pipe,  will  increase  its  ventilating  power  by  creating  a 
strong  and  constant  upward  current. 

Deodorization  of  the  contents  of  privies  may  be  secured  in 
a  measure  by  means  of  sulphate  of  iron,  phenyle,  carbolic  acid, 
or  dry  earth.  The  first  named  is  probably  the  most  economical, 
most  easily  applied,  and  very  effective.  A  solution  containing 
from  |  to  1  kilogramme  of  the  salt  in  4  litres  of  water  is  poured 
into  the  privy  as  often  as  necessary  to  prevent  offensive  odors. 
This  solution  may  be  conveniently  prepared  by  suspending  a 
basket  or  bag  containing  about  25  kilogrammes  of  the  sulphate 
in  a  barrel  of  water.  In  this  way  a  saturated  solution  will  be 
maintained  until  the  salt  has  been  entirely  dissolved.  Phenyle 
is  likewise  a  good  deodorizer  as  well  as  an  excellent  disinfectant. 

The  most  rigid  deodorization  by  chemicals  will,  however, 
be  less  effective  than  thorough  ventilation,  for  it  must  be  re- 
membered that  the  mere  destruction  of  an  offensive  odor  is  not 
equivalent  to  removing  all  the  deleterious  properties  that  may 
be  present.  It  is  not  at  all  certain  that  those  elements  of  sew- 
age which  are  the  most  offensive  to  the  sense  of  smell  are  most 
detrimental  to  health. 

Privies  should  be  emptied  of  their  contents  at  stated  inter- 
vals. A  strict  supervision  should  be  exercised  over  them  by  the 
municipal  authorities  in  cities  and  towns  to  prevent  overflowing 
of  their  contents. 

In  many  places  the  method  of  removing  the  contents  of 
privies  is  the  primitive  one  with  shovel,  or  dipper  and  bucket. 
In  most  cities  and  large  towns,  however,  the  privy- vaults  or  tanks 
are  now  emptied  by  means  of  one  of  the  so-called  odorless  excavat- 
ing machines,  of  which  there  are  a  number  of  different  patents. 


138  TEXT-BOOK    OF    HibfiiiiNJi. 

The  process  is  rarely  entirely  odorless,  however,  as  the  careless- 
ness of  the  workmen  frequently  permits  offensive  gases  to  escape 
and  pollute  the  air  for  a  considerable  distance.  All  the  different 
forms  of  the  apparatus  act  upon  the  pneumatic  principle.  One 
end  of  a  large  tube  is  carried  into  the  cess-pool  or  vault  to  be 
emptied  and  the  other  attached  to  a  pump,  by  means  of  which 
the  material  is  pumped  into  a  strong  barrel-tank  carried  on 
wheels.  At  the  top  of  the  tank  is  a  vent,  over  which  is  placed 
a  small  charcoal  furnace  to  consume  the  foul  gases  escaping 
from  the  vent. 

In  some  cities  and  many  of  the  smaller  towns  and  villages 
in  this  country  the  primitive  midden  or  pit  system  is  still  in  use. 
A  shallow  pit  is  dug  in  the  ground,  over  which  is  erected  the 
privy.  When  the  pit  is  full  another  is  dug  close  by  the  side  of 
it,  and  the  earth  from  the  new  pit  thrown  upon  the  excrement 
in  the  old  one.  The  privy  is  then  moved  over  the  new  pit,  and 
this  is  used  until  it  too  becomes  full.  The  proceeding  is  re- 
peated as  often  as  the  pit  becomes  filled  up  with  the  excreta, 
until  in  the  course  of  a  few  years  all  the  available  space  in  a 
yard  has  been  honey-combed  with  the  pits.  Then  the  custom 
adopted  in  overcrowded  cemeteries  is  followed,  namely,  the  first 
pit  is  dug  out  again  and  the  cycle  is  repeated. 

In  other  cities  the  privy-well  system  is  largely  in  use.  This 
is — next  to  the  midden  or  shallow  pit  just  described — the  most 
pernicious  system  for  the  disposal  of  excreta  that  can  be 
imagined.  The  wells  are  dug  to  such  a  depth  as  to  reach  the 
subterranean  flow  of  water,  in  which  the  excremental  matters 
are  constantly  carried  off.  Hence  these  receptacles  never  fill  up, 
and  never  need  cleaning.  For  this  reason  they  are  popular  with 
property  owners  ;  for,  next  to  the  primitive  midden,  they  are  the 
most  economical  of  all  the  various  methods  adopted.  The  utter 
perniciousness  of  the  system  is,  however,  plain,  because  the  soil 
for  a  considerable  distance  around  each  of  these  wells  becomes 
a  mass  of  putrid  filth,  contaminating  the  ground-water  which 
feeds  the  drinking-water  supplies  in  the  vicinity ;  polluting  also 


REMOVAL    OF    SEWAGE.  139 

the  ground-air,  which  eventually  reaches  the  surface,  or  the  in- 
terior of  houses,  when  the  pressure  of  the  outside  atmosphere 
diminishes  or  the  ground-water  level  rises.  It  must,  therefore, 
be  evident  that  the  best  ventilating  arrangements,  or  the  most 
thorough  and  consistent  disinfection,  can  have  very  little,  if  any, 
effect  in  removing  the  very  grave  objections  to  this  baneful 
system. 

The  privy-well  system  for  the  removal  of  excreta  cannot  be 
recommended  for  adoption  by  any  sanitarian. 

2.  The  Rochdale,  or  Pail-closet  System. — The  Rochdale 
system  of  removal  of  excreta  has  won  the  support  of  many  dis- 
tinguished sanitarians  on  account  of  its  simplicity,  its  economy, 
and  its  compliance  with  most  sanitary  requirements.  The  ex- 
creta, both  solid  and  liquid,  are  received  into  a  water-tight  pail, 
either  of  wood  or  metal,  and  removed  once  or  oftener  a  week, 
a  clean  and  disinfected  pail  being  substituted  for  the  one 
removed.  In  Rochdale,  Manchester,  and  Glasgow  in  Great 
Britain,  in  Heidelberg  in  Germany,  and  in  other  cities  abroad, 
where  this  system  has  been  introduced,  it  has  worked  satisfac- 
torily. In  this  country  a  modification  of  the  pail  system,  known 
as  the  Eagle  Sanitary  Closet,  has  been  introduced  by  a  firm  in 
Charleston,  S.  C.  The  receptacle  consists  of  an  enameled-iron 
reservoir,  with  a  neck  just  large  enough  to  fit  under  the  seat  of 
the  privy,  and  a  quantity  of  disinfectant  solution  is  put  into  the 
receptacle  to  prevent  putrefaction  of  the  excreta.  The  recep- 
tacles are  replaced  by  clean  ones  every  week. 

Mr.  James  T.  Gardner,  Director  of  the  New  York  State 
Sanitary  Survey,  says,  in  a  special  report  on  methods  of  sewerage 
applicable  in  small  towns  and  villages,  concerning  the  pail 
system1 : — 

"Rochdale  is  a  city  of  some  70,000,  and  Manchester  of 
between  400,000  and  500,000  inhabitants.  The  higher  class 
of  houses  are  allowed  to  have  water-closets,  but  four-fifths  of 
the  people  are  obliged  to  have  '  pail-closets  '  in  their  yards  built 

1  Second  Annual  Report  of  New  York  State  Board  of  Health,  pp.  322,  323. 


140  TEXT-BOOK   OF    HYGIENE. 

according  to  plans  of  the  Health  Department.  Their  essential 
features  are :  A  flag-stone  floor,  raised  a  few  inches  above  the 
level  of  the  yard ;  a  hinged  seat,  with  a  metal  rim  underneath 
for  directing  urine  into  the  pail,  which  stands  on  the  flag  directly 
beneath  the  seat ;  a  hinged  front  and  back  to  the  seat,  so  that 
the  pail  or  tub  may  be  easily  taken  out  and  the  place  cleaned; 
and  a  6-inch  ventilating  pipe  from  under  the  seat  to  above  the 
roof.  In  Rochdale  they  use  a  wooden  pail  or  tub  made  of  half 
of  a  disused  paraffine  cask,  holding  about  40  kilogrammes ;  in 
Manchester  the  '  pail '  is  of  galvanized  iron  and  holds  40  litres. 
Under  the  direction  of  the  authorities,  they  are  removed  once  a 
week  in  covered  vans,  which  bring  clean  tubs  to  be  put  in  the 
place  of  the  full  ones  taken  away.  Each  tub  is  covered  with  a 
close-fitting  double  lid  before  removal.  The  tubs  are  taken  to  a 
depot,  where  their  contents  are  deodorized  and  prepared  as 
manure  by  mixing  with  ashes  and  a  small  proportion  of  gypsum 
to  fix  the  ammonia.  Subsequently,  street-sweepings  and  the 
refuse  of  slaughter-houses  are  added.  At  Manchester  there  is 
by  the  side  of  each  closet  a  very  simple  ash-sifter,  from  which 
the  ashes  fall  into  the  tub  and  help  to  deodorize  its  contents. 

"  The  manure  at  Rochdale  sells  for  about  four-fifths  of  the 
cost  of  the  collection  and  preparation. 

"  In  1873  the  net  cost  to  the  town  of  removing  and  dispos- 
ing of  the  house  dry  refuse  and  excrement  was  only  about  $95 
per  annum  per  1000  of  population, — less  than  10  cents  a  person 
per  annum. 

"  The  system  has  been  in  operation  more  than  twelve  years. 

"  The  tubs  are  removed  in  the  day-time  without  offensive 
odor. 

"  Where  ashes  are  frequently  thrown  into  the  tubs  at  Man- 
chester, very  little  odor  is  to  be  perceived  in  the  closets. 

"  For  the  villages  of  the  State,  which  can  have  no  general 
water-supply,  I  would  unhesitatingly  advise  the  use  of  the 
'  pail '  or  tub  system  as  practiced  in  Manchester,  England,  as 
being,  from  a  sanitary  point  of  view,  an  immense  improvement 


REMOVAL    OF    SEWAGE.  141 

over  the  death-breeding  privy-vaults  in  common  use.  The 
cheapness  of  the  plan  and  the  smallness  of  the  original  outlay 
of  brains  and  money,  in  comparison  with  that  needed  to  build 
a  good  sewer  system,  will  make  it  possible  to  introduce  a  tub- 
privy  system  into  most  villages  half  a  century  before  sewers 
would  meet  with  any  consideration. 

"  At  a  small  cost  the  existing  privy- vaults  can  be  cleaned 
and  rilled,  and  the  privies  altered  into  healthful  tub-closets.  The 
town  authorities  must  then  arrange  for  the  removal  of  the  tubs 
once  a  week,  and  for  their  thorough  cleansing  and  disinfecting. 
Any  isolated  house,  or  group  of  houses,  can  use  the  tub  system, 
taking  care  of  it  themselves.  If  the  plan  is  adopted  in  villages 
it  will  doubtless  spread  into  the  country,  and  become  the  most 
powerful  means  of  abolishing  the  fatal  privy-vaults  which  are 
poisoning  the  farm-wells." 

3.  Earth-  and  Ash-  Closets. — The  earth-  and  ash-  closets 
are  devices  in  use  to  a  large  extent  in  England,  and  to  a  less 
degree  in  this  country,  for  the  purpose  of  rendering  human  ex- 
creta inodorous  by  covering  them  immediately  after  they  are 
voided  with  dry  earth  or  ashes.  The  earth-closet  is  the  inven- 
tion of  the  Rev.  Henry  Moule,  of  England,  and  consists  of  an 
ordinary  commode  or  closet,  the  essential  feature  of  which  is  a 
reservoir  containing  dried  earth  or  ashes,  a  quantity  of  which, 
amounting  to  about  twice  the  quantity  of  feces  voided,  is  thrown 
upon  the  evacuation  either  by  hand  or  by  means  of  an  auto- 
matic apparatus  called  a  "chucker."  Just  as  in  the  ordinary 
water-closet,  by  raising  a  handle  a  supply  of  water  is  thrown 
into  the  hopper  to  wash  down  the  faeces  into  the  soil-pipe,  so,  in 
the  usual  form  of  the  earth-closet,  raising  the  handle  projects  a 
quantity  of  earth  upon  the  evacuated  faeces  and  urine.  By  this 
means  the  excreta  are  rendered  entirely  inodorous  and  dry. 
The  contents  of  the  closets  may  be  collected  into  a  heap  in  a 
dry  place.  In  the  course  of  a  few  months  the  organic  constit- 
uents have  become  oxidized,  and  the  earth  may  be  used  over 
again  for  a  number  of  times.     A  well-known  sanitarian  states 


142 


TEXT-BOOK    OF    HYGIENE. 


that  he  has  used  sifted  anthracite  coal-ashes  ten  or  twelve  times 
over  in  the  course  of  three  years.  During  this  time  the  material 
under  no  circumstances  gave  any  indication  that  it  was  "  any- 
thing but  ashes,  with  a  slight  admixture  of  garden  soil."1 

Dr.  Buchanan,  of  England,  comparing  the  advantages  of 
the  earth-closet  with  those  of  the  water-closet,  says:  "It  is 
cheaper  in  original  cost ;  it  requires  less  repairs ;  it  is  not  in- 
jured by  frost ;  it  is  not  damaged  by  improper  substances  being 


Fig.  4.  —  Pull-up  Handle  Commode, 
showing  the  door  open  for  remov- 
ING Pail.  The  Flap  of  the  Seat 
and  Earth-Reservoir  are  also  Par- 
tially Raised  to  show  the  Con- 
struction. 


Fig.  5.— Showing  the  Apparatus 
Mounted  on  Bearers  as  when 
Fixed.  Seat  Removed,  showing  Me- 
chanical Arrangement. 


thrown  down  it ;  and  it  very  greatly  reduces  the  quantity  of 
water  required  by  each  household."2 

In  cities  and  towns  the  removal  of  the  excreta  should  be 
carried  out  by  or  under  the  immediate  direction  of  the  mu- 
nicipal sanitary  authorities.  If  this  is  neglected,  abuses  are 
liable  to  creep  in  which  will  vitiate  the  performance  of  any 
system,  however  faultless,  if  properly  managed. 

Many  advocates  of  the  pail,  dry  earth,  or  privy  systems  urge 
the  advantage  of  the  large  quantity  of  valuable  manure  which 

1  The  Sanitary  Drainage  of  Houses  and  Towns,  Waring,  p.  250.    2d  ed.,  1881. 

2  Quoted  in  Waring,  above  cited,  p.  264. 


REMOVAL   OF    SEWAGE.  143 

can  be  realized  by  converting  the  excremental  matters  into  pou- 
drette  and  other  fertilizing  compounds.  Experience  has  shown, 
however,  that  the  cost  of  preparing  a  satisfactory  fertilizer  from 
human  excrement  is  much  greater  than  can  be  realized  from  its 
sale.  In  all  places  in  Great  Britain  and  the  continent  of  Europe 
where  it  has  been  tried  the  decision  is  against  its  practicability. 
The  agricultural  consideration  should,  however,  be  a  secondary 
one,  if  the  systems  mentioned  are  economical  and  meet  the 
sanitary  requirements  (which  the  privy  system  certainly  does 
not).  The  adoption  of  one  or  other  of  them  may  be  secured 
where  more  perfect  but  more  complicated  and  expensive  systems 
may  be  out  of  the  question. 

4.  The  Pneumatic  System  of  Liernur. — A  system  which 
seems  to  be  useful  in  larger  cities,  especially  where  the  topo- 
graphical conditions  are  such  as  to  render  necessary  mechanical 
aid  in  overcoming  obstacles  to  natural  drainage,  is  the  pneu- 
matic system  devised  by  Captain  Liernur,  of  Holland,  and 
generally  known  as  the  Liernur  system.  It  consists  of  a  set  of 
soil-pipes  running  from  the  water-closets  to  central  district 
resti  soil's,  from  which  the  air  is  exhausted  at  stated  intervals. 
When  a  vacuum  is  created  in  the  reservoir  the  contents  of  the 
water-closets  and  soil-pipes  are  driven  forcibly  into  the  reservoir 
by  the  pressure  of  air.  The  district  reservoirs  are  connected  by 
a  separate  system  of  pipes  with  a  main  depot,  and  the  transfer 
of  the  faecal  matter  from  the  former  to  the  latter  is  also  accom- 
plished with  the  aid  of  pneumatic  pressure.  The  complete 
system  of  Liernur  provides  that  at  the  main  depot  the  faecal 
matter  shall  be  treated  with  chemicals,  evaporated,  and  con- 
verted into  a  dry  fertilizer — poudrette.  It  appears  from  the 
published  reports  that  while  the  system  has  been  partially 
adopted  in  three  Dutch  cities,  in  only  one  of  them,  Dortrecht, 
has  the  machinery  for  manufacturing  poudrette  been  established. 
With  reference  to  this  Erismann *  says :  "  It  seems  never  to  have 

1  Von  Pettenkofer  und  Ziemssen.  Handbuch  der  Hygiene.  II  Th.,  II  Abth,  1  Hlfte, 
p.  140. 


144  TEXT-BOOK   OF   HYGIENE. 

been  in  regular  working  order,  for  the  faecal  masses  are  mixed 
with  street-sweepings  and  ashes  into  a  compost-mass,  which 
causes  no  little  discomfort  in  the  neighborhood  by  the  offensive 
odors.  In  Amsterdam  the  faecal  matters,  which  frequently  do 
not  find  a  ready  sale,  are  partly  made  into  a  compost  with 
sweepings,  partly  used  to  fertilize  meadows,  or  simply  discharged 
into  the  water." 

As  to  the  practical  working  of  the  system  the  opinions 
differ  widely.  While  the  majority  of  sanitarians,  including 
Virchow,  von  Pettenkofer,  and  Mr.  Rawlinson,  object  to  it  as 
not  fulfilling  the  demands  of  hygiene,  the  system  has  also  been 
criticized  by  engineers  as  not  being  in  accordance  with  the  well- 
known  principles  of  their  science.1 

Two  other  plans  for  the  removal  of  fsecal  matter  by  pneu- 
matic pressure  have  been  invented,  namely,  the  Shone  and  the 
Berber  systems.  Neither  of  these  has  been  adopted  to  any 
considerable  extent.  Both  seem  to  the  author  to  fall  far  short 
even  of  the  merits  of  the  Liernur  system. 

5.  The  Water- Carriage  System  of  Seiuerage. — Two  sys- 
tems of  removal  of  sewage  by  water-carriage  are  in  use  at  the 
present  time.  They  are  technically  known  as  the  "  combined  " 
and  the  "  separate  "  systems.  In  the  former,  which  is  the  sys- 
tem upon  which  the  most  of  the  sewers  in  this  country  are 
constructed,  all  excreta,  kitchen-slops,  waste-water  from  baths 
and  manufacturing  establishments,  as  well  as  storm-water,  are 
carried  off  in  the  same  conduits.  In  the  separate  system,  on 
the  other  hand,  the  removal  of  the  storm-water  is  provided  for, 
either  by  surface  or  under-ground  drains,  not  connected  with  the 
sewers  proper,  in  which  only  the  discharge  from  water-closets 
and  the  refuse-water  from  houses  and  factories  are  conveyed. 
In  the  separate  system  the  pipes  are  of  such  small  calibre  that 
a   constant   flow  of   their    contents   is   maintained,  preventing 

1  Papers  by  Maj.  C.  H.  Latrobe  arid  Col.  Geo.  E.  Waring,  Jr.,  in  Fifth  Biennial  Report 
Md.  State  Board  of  Health.  See  also,  in  favor  of  system,  a  paper  by  Dr.  C  W.  Chancellor,  in 
same  publication,  and  an  elaborate  description  by  the  same  author  in  Trans.  Med.  and  Chir. 
Faculty  of  Md.,  1883. 


REMOVAL    OF    SEWAGE.  145 

deposition  of  suspended  matters  and  diminishing  decomposition 
and  the  formation  of  sewer-gas. 

In  the  combined  system,  on  the  other  hand,  the  sewers 
must  be  made  large  enough  to  receive  the  maximum  rain-fall  of 
the  district.  This  requires  a  calibre  greatly  in  excess  of  the 
ordinary  needs  of  the  sewer,  and  furnishes  favorable  conditions 
for  the  formation  of  sewer-gas  and  the  development  of  minute 
vegetable  organisms.  The  ordinary  flow  in  a  sewer  of  large 
calibre  is  usually  so  sluggish  as  to  promote  the  deposition  of 
solid  matters  and  the  gradual  obstruction  of  the  sewer. 

It  is  the  opinion  of  the  most  advanced  sanitarians  that  the 
separate  system  fulfills  the  demands  of  a  rational  system  of 
sewerage  better  than  any  other  at  present  in  use.  The  objec- 
tions to  the  combined  system  are  so  many  and  so  great  that  it 
does  not  seem  advisable  for  sanitary  authorities  to  recommend 
the  construction  of  sewers  on  this  principle  in  the  future. 

The  separate  system  of  sewerage,  indorsed  as  it  is  by  high 
engineering  and  sanitary  authorities,  and  by  a  satisfactory,  prac- 
tical test  of  nine  years  in  the  city  of  Memphis  and  of  six  years 
in  the  town  of  Keene,  N.  H.,  seems  to  the  author  to  possess 
merits  above  any  other  plan  for  the  removal  of  excreta  and 
house-wastes.  The  following  description  is  from  a  paper  by 
Col.  George  E.  Waring,  Jr. :  "A  perfect  system  of  sanitary 
sewerage  would  be  something  like  the  following:  No  sewer 
should  be  used  of  a  smaller  diameter  than  6  inches  (15  centi- 
metres): a,  because  it  will  not  be  safe  to  adopt  a  smaller  size 
than  4-inch  (10  centimetres)  for  house-drains,  and  the  sewer 
must  be  large  enough  to  surely  remove  whatever  may  be  de- 
livered by  these;  b,  because  a  smaller  pipe  than  6-inch  would 
be  less  readily  ventilated  than  is  desirable;  c,  and  because  it  is 
not  necessary  to  adopt  a  smaller  radius  than  3  inches  (5  centi- 
metres) to  secure  a  cleansing  of  the  channel  by  reasonably 
copious  flushing. 

"No  sewer  should  be  more  than  6  inches  (15  centimetres) 
in    diameter,   until   it  and   its    branches   have   accumulated  a 


146  TEXT-BOOK    OF    HYGIENE. 

sufficient  flow  at  the  hour  of  greatest  use  to  fill  this  size  half  full, 
because  the  use  of  a  larger  size  would  he  wasteful,  and  because 
when  a  sufficient  ventilating  capacity  is  secured,  as  it  is  in  the 
use  of  a  6-inch  pipe,  the  ventilation  becomes  less  complete  as 
the  size  increases,  leaving  a  larger  volume  of  contained  air  to 
be  moved  by  the  friction  of  the  current,  or  by  extraneous  in- 
fluences, or  to  be  acted  upon  by  changes  of  temperature  and 
of  volume  of  flow  within  the  sewer. 

"The  size  should  be  increased  gradually,  and  only  so 
rapidly  as  is  made  necessary  by  the  filling  of  the  sewer  half 
full  at  the  hour  of  greatest  flow. 

"  Every  point  of  the  sewer  should,  by  the  use  of  gaskets 
or  otherwise,  be  protected  against  the  least  intrusion  of  cement, 
which,  in  spite  of  the  greatest  care,  creates  a  roughness  that  is 
liable  to  accumulate  obstructions. 

"  The  upper  end  of  each  branch  sewer  should  be  provided 
with  a  Field's  flush-tank  of  sufficient  capacity  to  secure  the 
thorough  daily  cleansing  of  so  much  of  the  conduit  as  from  its 
limited  flow  is  liable  to  deposit  solid  matters  by  the  way. 

"  There  should  be  sufficient  man-holes,  covered  by  open 
gratings,  to  admit  air  for  ventilation.  If  the  directions  already 
given  are  adhered  to,  man-holes  will  not  be  necessary  for  cleans- 
ing. The  use  of  the  flush-tank  will  be  a  safeguard  against 
deposit.  With  the  system  of  ventilation  about  to  be  described, 
it  will  suffice  to  place  the  man-holes  at  intervals  of  not  less  than 
1000  feet  (305  metres). 

"  For  the  complete  ventilation  of  the  sewers  it  should  be  made 
compulsory  for  every  householder  to  make  his  connection  without 
a  trap,  and  to  continue  his  soil-pipe  above  the  roof  of  his  house. 
That  is,  every  house  connection  should  furnish  an  uninter- 
rupted ventilation-channel  4  inches  (10  centimetres)  in  diameter 
throughout  its  entire  length.  This  is  directly  the  reverse  of  the 
system  of  connection  that  should  be  adopted  in  the  case  of 
storm-water  and  street-wash  sewers.  These  are  foul,  and  the 
volume  of  their  contained  air  is  too  great  to  be  thoroughly  ven- 


REMOVAL   OF    SEWAGE.  147 

tilated  by  such  appliances.  Their  atmosphere  contains  too  much 
of  the  impure  gases  to  make  it  prudent  to  discharge  it  through 
house-drains  and  soil-pipes.  With  the  system  of  small  pipes 
now  described,  the  flushing  would  be  so  constant  and  complete 
and  the  amount  of  ventilation  furnished,  as  compared  to  volume 
of  air  to  be  changed,  would  be  so  great,  that  what  is  popularly 
known  as  '  sewer-gas '  would  never  exist  in  any  part  of  the 
public  drains.  Even  the  gases  produced  in  the  traps  and  pipes 
of  the  house  itself  would  be  amply  rectified,  diluted,  and  removed 
by  the  constant  movement  of  air  through  the  latter. 

"All  house  connections  with  the  sewers  should  be  through 
inlets  entering  in  the  direction  of  the  flow,  and  these  inlets 
should  be  funnel-shaped  so  that  their  flow  may  be  delivered  at 
the  bottom  of  the  sewer,  and  so  that  they  may  withdraw  the  air 
from  its  crown;  that  is,  the  vertical  diameter  of  the  inlet  at  its 
point  of  junction  should  be  the  same  as  the  diameter  of  the 
sewer. 

"All  changes  of  direction  should  be  on  gradual  curves,  and, 
as  a  matter  of  course,  the  fall  from  the  head  of  each  branch  to 
the  outlet  should  be  continuous.  Reduction  of  grade  within 
this  limit,  if  considerable,  should  always  be  gradual. 

"So  far  as  circumstances  will  allow,  the  drains  should  be 
brought  together,  and  they  should  finally  discharge  through  one 
or  a  few  main  outlets. 

"The  outlet,  if  water-locked,  should  have  ample  means  for 
the  admission  of  fresh  air.  If  open,  the  mouth  should  be  pro- 
tected against  the  direct  action  of  the  wind. 

"It  will  be  seen  that  the  system  of  sewerage  here  described 
is  radically  different  from  the  usual  practice.  It  is  cleaner,  is 
much  more  completely  ventilated,  and  is  more  exactly  suited  to 
the  work  to  be  performed.  It  obviates  the  filthy  accumulation 
of  street-manure  in  catch-basins  and  sewers,  and  it  discharges  all 
that  is  delivered  to  it  at  the  point  of  ultimate  outlet  outside  the 
town  before  decomposition  can  even  begin.  If  the  discharge  is 
of  domestic  sewage  only,  its  solid  matter  will  be  consumed  by 


148  TEXT-BOOK   OF   HYGIENE. 

fishes  if  it  is  delivered  into  a  water-course,  and  its  dissolved 
material  will  be  taken  up  by  aquatic  vegetation. 

"The  limited  quantity  and  the  uniform  volume  of  the 
sewage,  together  with  the  absence  of  dilution  by  rain-fall,  will 
make  its  disposal  by  agricultural  or  chemical  processes  easy  and 
reliable. 

"The  cost  of  construction,  as  compared  with  that  of  the 
most  restricted  storm- water  sewers,  will  be  so  small  as  to  bring 
the  improvement  within  the  reach  of  the  smaller  communities. 

"In  other  words,  while  the  system  is  the  best  for  large 
cities,  it  is  the  only  one  that  can  be  afforded  in  the  case  of 
small  towns. 

"  Circumstances  are  occasionally  such  as  to  require  extensive 
engineering  works  for  the  removal  of  storm- water  through  very 
deep  channels.  Ordinarily,  the  removal  of  storm-water  is  a  very 
simple  matter,  if  we  will  accept  the  fact  that  it  is  best  carried, 
so  far  as  possible,  by  surface  gutters,  or,  in  certain  cases,  by 
special  conduits,  placed  near  the  surface. 

"  It  is  often  necessary,  in  addition  to  the  removal  of  house- 
waste,  to  provide  for  the  drainage  of  the  subsoil.  This  should 
not  be  effected  by  open  joints  in  the  sewers;  because  the  same 
opening  that  admits  soil-water  may,  in  dry  seasons  and  porous 
soils,  permit  the  escape  of  sewage  matters  into  the  ground, 
which  is  always  objectionable. 

"  Soil-water  drains  may  be  laid  in  the  same  trench  with  the 
sewers,  but  preferably,  unless  they  have  an  independent  outlet, 
on  a  shelf  at  a  higher  level.  When  they  discharge  into  the 
sewer  they  should  always  deliver  into  its  upper  part,  or  into  a 
man-hole  at  a  point  above  the  flow-line  of  the  sewage."1 

The  establishment  of  a  system  of  sewerage  presupposes  a 
constant  and  abundant  supply  of  water  to  keep  all  closets  clean 
and  all  house-drains  and  street-sewers  well  flushed.  Where  this 
cannot  be  obtained,  sewers  would  be  likely  to  prove  greater 
evils  than  benefits.     In  such  cases  one  of  the  methods  of  removal 

1  The  Sewering  and  Drainage  of  Cities,  Waring,  Public  Health,  vol.  v,  p.  35. 


REMOVAL    OF    SEWAGE.  149 

of  excreta  before  mentioned,  either  the  pail-  or  earth-  closet 
system,  should  be  adopted. 

The  final  disposal  of  sewage  is  a  problem  that  depends  for 
its  solution  partly  upon  the  agricultural  needs  of  the  country 
around  the  city  to  be  sewered,  partly  upon  the  proximity  of 
large  bodies  of  water  or  running  streams.  When  the  city  is 
situated  upon  or  near  large  and  swiftly-flowing  streams,  the 
sewage  may  be  emptied  directly  into  the  stream  without  seriously 
impairing  the  purity  of  the  latter,  although  the  principle  of  thus 
disposing  of  sewage  is  wrong.  Dilution,  deposition,  and  oxida- 
tion will  soon  remove  all  appreciable  traces  of  the  sewage  of 
even  the  largest  cities.  Where,  on  the  other  hand,  the  stream 
is  inadequate  in  size  to  carry  off  the  sewage,  or  where,  as  in  the 
Seine  and  Thames,  the  current  is  sluggish,  some  other  method 
of  final  disposal  must  be  adopted. 

In  many  cities  of  Great  Britain  and  the  continent  of  Europe 
the  disposal  of  the  sewage  by  irrigation  of  cultivated  land  has 
been  practiced  for  a  number  of  years.  The  reports  upon  the 
working  of  the  system  are  generally  favorable,  although  some 
sanitarians  express  doubts  of  the  efficiency  of  the  system.  In 
using  sewage  for  the  irrigation  of  land,  two  objects  are  secured: 
first,  the  fertilization  of  the  land  by  the  manurial  constituents 
of  the  sewage,  and,  second,  the  purification  of  the  liquid  portion 
by  filtration  through  the  soil.  The  organic  matters  which  have 
been  held  back  by  the  soil  undergo  rapid  oxidation  in  the  presence 
of  air  and  the  bacteria  of  decay,  and  are  converted  into  plant- 
food,  or  into  harmless  compounds.  Sewage  irrigation,  as  prac- 
ticed in  Europe,  must  make  provision  for  the  disposal  of  a  very 
large  proportion  of  water  in  the  sewage  (street-wash,  storm- 
water),  which  requires  much  larger  areas  of  land  than  would  be 
needed  if  only  sewage  material  proper  (water-closet  and  kitchen- 
waste)  was  to  be  thus  disposed  of.  In  this  country  a  practical 
experiment  has  recently  been  made  at  Pullman,  Illinois,  delivering 
only  the  sewage  materials  above  mentioned  upon  the  irrigation 
area.     The  success  of  the  experiment  is  said  to  be  satisfactory. 


150  TEXT-BOOK    OF   HYGIENE. 

All  land  used  for  sewage  irrigation  should  be  drained  with 
drain- tile  at  a  depth  of  3  to  6  feet  (1  to  2  metres)  below  the 
surface,  in  order  to  promote  a  rapid  carrying  off  of  the  watery 
portion  of  the  sewage,  purified  by  filtration  through  the  soil.  A 
sandy  loam  is  the  best  soil  for  irrigation.  Clay  is  not  sufficiently 
permeable  to  air  and  water,  while  pure  sand  allows  the  sewage 
to  pass  through  too  readily,  before  the  organic  matters  in  it 
have  been  sufficiently  oxidized.  It  has  been  shown  that  the 
roots  of  plants  assist  largely  in  the  oxidation  of  organic  matter. 

The  entire  process  of  collecting  and  finally  disposing  of 
sewage  matters,  from  the  moment  they  are  received  in  the  house- 
receptacles  until  discharged  into  the  swiftly-flowing  stream  or  on 
the  sewage  farm,  should  be  void  of  offense  to  the  senses  of  sight 
or  smell.  With  a  proper  construction  and  management  of 
sewerage  works,  on  the  lines  indicated  in  this  chapter,  it  is 
believed  these  results  can  be  attained. 

During  the  past  two  or  three  years  a  number  of  experi- 
ments have  been  made  in  this  country  with  various  processes  for 
the  disposal  of  excreta  and  garbage  by  cremation.  In  a  general 
way  the  principle  may  be  pronounced  a  success,  although  its 
proper  application  in  practice  is  still  under  discussion. 

[The  following  works  give  fuller  details  upon  the  matters 
treated  in  the  two  foregoing  chapters: — 

Erismann,  Entfernung  der  Abfallstoffe.  Hdbch.  d.  Hygiene,  etc., 
II  Th.,  I  Abth.,  1  Hlffce.— C.  F.  Folsom,  Seventb  Report  Mass.  State 
Board  of  Healtb,  1876,  p.  276. — Soyka,  Stiidte-reinigung,  in  Realenc}r- 
clopsedie  d.  ges.  Heilk.,Bd.  xiii,  p.  14  et  seq. — Pettenkofer,  Tbe  Sanitary- 
Relations  of  the  Soil,  in  Pop.  Sci.  Monthly,  vol.  xx,  p.  332,  468. — Rohe, 
Address  on  State  Medicine,  in  Journ.  Am.  Med.  Ass'n,  July,  1887. — Cor- 
field  and  Parkes,  The  Treatment  and  Utilization  of  Sewage,  1887. — Re- 
ports of  the  Committee  on  Destruction  of  Garbage  and  Refuse,  Public 
Health,  vols,  xiv  and  xv.] 


CHAPTER  VI. 

Construction  of  Habitations. 


The  importance  of  observing  the  principles  of  hygiene  in 
the  construction  of  habitations  for  human  beings  is  not  suffi- 
ciently appreciated  by  the  public.  Architects  and  builders  them- 
selves have  not  kept  pace  with  the  sanitarian  in  the  study  of  the 
conditions  necessary  to  be  observed  in  building  a  dwelling-house 
which  shall  answer  the  requirements  of  sanitary  science. 

In  an  investigation  conducted  by  Dr.  Villerme1  it  was  found 
that  in  France,  from  1821  to  1827,  of  the  inhabitants  of  arron- 
dissements  containing  7  per  cent,  of  badly-constructed  dwellings, 
1  person  out  of  every  72  died ;  of  inhabitants  of  arrondissements 
containing  22  per  cent,  of  badly-constructed  dwellings,  1  out  of 
65  died  ;  while  of  the  inhabitants  of  arrondissements  containing 
38  per  cent,  of  badly-constructed  dwellings,  1  out  of  every  45  died. 

Inseparable  from  the  question  of  the  defective  construction 
of  dwellings  is  that  of  overcrowding  in  cities,  because  the  most 
crowded  portions  of  a  city  are  at  the  same  time  those  in  which 
the  construction  of  dwellings  is  most  defective  from  a  hygienic 
stand-point.  The  following  tables  show  the  relations  of  the 
death-rate  to  density  of  population  in  various  large  cities  of 
Europe,  and  also  the  relations  between  overcrowding  in  dwell- 
ings and  the  mortality  from  contagious  diseases  : — 

Table  XVII. 

RELATION   OF   DEATH-RATE    TO   DENSITY   OF   POPULATION. 


City. 

Mean  Number  of  Inhab- 
itants to  each  House. 

Average  Death-rate  per 
1000  Inhabitants, 

8 
32 
35 
52 
55 

24 

25 
28 
41 
47 

i  (Quoted  in  Realencyclopgedia  d.  ges,  Heilk,  Bd.  ii,  71. 


(151) 


152  TEXT-BOOK    OF   HYGIENE. 

In  Glasgow,  the  death-rate  in  apartments  with  1.31  occu- 
pants is  21.7  per  1000,  while  in  apartments  with  2.05  occupants 
the  rate  is  28.6  per  1000. 

In  Buda-Pesth,  in  1872-73, it  was  found  that  outof  every  100 
deaths  from  all  causes  there  were,  from  contagious  diseases : — 

20  deaths  in  dwellings  with  1  to    2  persons  in  each  room. 

on         u  it  (<  "       3    "       5  "  "        "  " 

32       «        «         "  "     g  "   10        "         "      "         " 

79       "        "         "  "    over  10        "         "      "         " 

Dr.  Jose  A.  de  los  Rios  gives  the  following  statistics,  bear- 
ing upon  the  mortality  of  cholera,  in  relation  to  the  number  of 
persons  occupying  one  room  when  attacked  by  it : — 

Of  10,000  persons  attacked  by  cholera,  and  living  1  person 
to  the  room,  68  died. 

Of  10,000  persons  attacked  by  cholera,  from  1  to  2  to  the 
room,  131  died. 

Of  10,000  persons  attacked  by  cholera,  living  2  to  4  to  the 
room,  219  died. 

Of  10,000  persons  attacked  by  cholera,  living  4  or  more  to 
the  room,  327  died. 

These  figures  show  very  clearly  the  vital  importance  of  the 
application  of  sanitary  laws  in  the  construction  and  occupation 
of  dwellings. 

Another  curious  and  suggestive  point  is  presented  by  some 
statistical  researches  on  the  mortality  of  Berlin,  in  regard  to  the 
death-rate  among  persons  living  in  different  stories  of  houses.  It 
was  found,  for  example,  that  the  mortality  in  fourth-story  dwell- 
ings is  higher  than  in  the  lower  stories.  Even  basement  dwell- 
ings  furnish  a  lower  death-rate.  Still-births,  especially,  occur 
in  a  larger  proportion  among  the  occupants  of  the  upper  stories 
of  houses.  This  may  be  explained  by  the  unfavorable  effects  of 
frequent  stair-climbing,  especially  in  pregnant  women. 

It  is  in  the  death-rate  among  young  children  that  the  effects 
of  overcrowding  and  unsanitary  construction  of  dwellings  are 
especially  manifest.     The  mortality  returns  from  all  the  large 


CONSTRUCTION    OF    HABITATIONS. 


153 


cities    of   the   world   give    mournful    evidences    of    this    every 
summer. 

The  researches  of  Dr.  H.  I.  Bowditch  upon  soil-wetness,  to 
which  reference  has  already  been  made  in  a  previous  chapter, 
snow  conclusively  that  persons  living  in  houses  situated  upon 
or  near  land  habitually  or  excessively  wet,  are  especially  prone 
to  be  attacked  by  pulmonary  consumption.  Dr.  Buchanan1  has 
corroborated  the  truth  of  Dr.  Bowditch's  observations  by  show- 
ing-, from  the  records  of  a  number  of  cities  and  towns  of  Great 
Britain,  that,  with  the  introduction  of  a  good  drainage  system, 
bringing  about  a  depression  and  uniformity  of  level  of  the 
ground-water,  the  mortality  from  consumption  and  other  dis- 
eases very  markedly  diminished.  The  following  table,  showing 
the  proportionate  amount  of  this  diminution,  is  abridged  from 

the  official  reports2 : — 

Table  XVIII. 

RESULTS   OF    SANITARY   WORK. 


Name  of  Place. 

Population 
in  1861. 

Average 
Mortality  per 

1000  before 
Construction 

of  Works. 

Average 
Mortality 

per  1000 
since  Com- 
pletion of 
Works. 

Saving  of 

Life 
(percent.). 

Reduc- 
tion of 

Typhoid 
Fever 

Rate  (per 
cent.) . 

Reduc- 
tion in 
Rate  of 
Phthisis 
(percent.). 

Banbury     .     . 

10,233 

23.4 

20.5 

m 

48 

41 

Cardiff  .     .     . 

32,954 

38.2 

22.6 

32 

40 

17 

Croydon     .     . 

30,229 

23.7 

18.6 

22 

63 

17 

Dover    .     .     . 

23,108 

22.6 

20.9 

7 

36 

20 

Ely    ...     . 

7,847 

23.9 

20.5 

14 

56 

47 

Leicester    . 

68,056 

26.4 

25.2 

4^ 

48 

32 

Macclesfield    . 

27,475 

29.8 

23.7 

20 

48 

31 

Merthyr      .     . 

52,778 

33.2 

26.2 

18 

60 

11 

Newport     .     . 

24,756 

31.8 

21.6 

32 

36 

32 

Ru^by    .     .     . 

7,818 

19.1 

18.6 

H 

10 

43 

Salisbury    .     . 

9,030 

27.5 

21.9 

20 

75 

49 

Warwick    .     . 

10,570 

22.7 

21.0 

n 

52 

19 

The  following  points  must  be  taken  into  account  in  building 
a  house  in  accordance  with  sanitary  principles  : — 

i. — SITE. 

The    building-site    should   be    protected    against    violent 
winds,  although  a  free  circulation  of  air  all  around  the  house 

1  Ninth  and  Tenth  Reports  of  the  medical  officer  to  the  Privy  Council. 

2  Sanitary  Engineering,  Baldwin  Latham,  p.  2.    Chicago,  1877. 


154  TEXT-BOOK   OF   HYGIENE. 

must  be  secured.  Close  proximity  to  cemeteries,  marshes,  and 
injurious  manufacturing  establishments  or  industries  must  be 
avoided  if  possible.  A  requisite  of  the  highest  importance  is 
the  ability  to  command  an  abundant  supply  of  pure  water  for 
drinking  and  other  purposes.  A  neglect  of  this  precaution  will 
be  sure  to  result  to  the  serious  inconvenience,  if  not  detriment, 
of  the  occupants  of  the  house. 

II. CHARACTER    OF    THE    SOIL. 

The  soil  should  be  porous  and  free  from  decomposing  ani- 
mal or  vegetable  remains,  or  excreta  of  man  or  animals.  It 
should  be  freely  permeable  to  air  and  water,  and  the  highest 
level  of  the  ground-water  should  never  approach  nearer  than 
3  metres  to  the  surface.  The  fluctuations  of  the  ground-water 
level  should  be  limited.  In  this  connection,  attention  is  again 
called  to  the  aphorism  of  Dr.  DeChaumont. 1 

It  is  impossible  to  say  positively  that  any  kind  of  soil  is 
either  healthy  or  unhealthy,  merely  from  a  knowledge  of  its 
geological  characters.  The  accidental  modifying  conditions 
above  referred  to,  viz.,  organic  impurities,  moisture,  the  level 
and  fluctuations  of  'the  ground-water,  are  of  much  greater 
importance  than  mere  geological  formation.  The  late  Dr. 
Parkes,  however,  regarded  the  geological  structure  and  conforma- 
tion as  of  no  little  importance,  and  summarized  the  sanitary 
relations  of  soils,  variously  constituted,  as  follows2: — 

"  1.  The  Granitic,  Metamorphic,  and  Trap  Rocks. — Sites 
on  these  formations  are  usually  healthy;  the  slope  is  great,  water 
runs  off  readily;  the  air  is  comparatively  dry;  vegetation  is  no,t 
excessive;  marshes  and  malaria  are  comparatively  infrequent; 
and  few  impurities  pass  into  the  drinking-water. 

"When  these  rocks  have  been  weathered  and  disintegrated 
they  are  supposed  to  be  unhealthy.  Such  soil  is  absorbent  of 
water;  and  the  disintegrated  granite  of  Hong  Kong  is  said  to 

»  Chapter  iv,  p  130. 

a  Practical  Hygiene,  6th  eel.,  vol.  i,  p.  359. 


CHARACTER    OF    THE    SOIL.  155 

be  rapidly  permeated  by  a  fungus;  but  evidence  as  to  the  effect 
of  disintegrated  granite  or  trap  is  really  wanting. 

"In  Brazil  the  syenite  becomes  coated  with  a  dark  sub- 
stance and  looks  like  plumbago,  and  the  Indians  believe  this 
gives  rise  to  'calentura,'  or  fevers.  The  dark  granitoid,  or 
metamorphic  trap,  or  hornblendic  rocks  in  Mysore,  are  also  said 
to  cause  periodic  fevers;  and  iron  hornblende,  especially,  was 
affirmed  by  Dr.  Heyne,  of  Madras,  to  be  dangerous  in  this 
respect.  But  the  observations  of  Bichter  on  similar  rocks  in 
Saxony,  and  the  fact  that  stations  on  the  lower  spurs  of  the 
Himalayas  on  such  rocks  are  quite  healthy,  negative  Heyne's 
opinion. 

"  2.  The  Clay  Slate. — These  rocks  precisely  resemble  the 
granite  and  granitoid  formations  in  their  effect  on  health.  They 
have  usually  much  slope,  are  very  impermeable,  vegetation  is 
scanty,  and  nothing  is  added  to  air  or  drinking-water. 

"They  are  consequently  healthy.  Water,  however,  is 
often  scarce,  and  as  to  the  granite  districts,  there  are  swollen 
brooks  during  rain,  and  dry  water-courses  at  other  times  swelling 
rapidly  after  rains. 

"3.  The  Limestone  and  Magnesian  Limestone  Rocks. — 
These  so  far  resemble  the  former  that  there  is  a  good  deal  of 
slope  and  rapid  passing  off  of  water.  Marshes,  however,  are 
more  common,  and  may  exist  at  great  heights.  In  that  case, 
the  marsh  is  probably  fed  with  water  from  some  of  the  large 
cavities  which  in  the  course  of  ages  become  hollowed  out  in  the 
limestone  rocks  by  the  carbonic  acid  in  the  rain,  and  form 
reservoirs  of  water. 

"The  drinking-water  is  hard,  sparkling,  and  clear.  Of 
the  various  kinds  of  limestone,  the  hard  oolite  is  best  and 
magnesian  is  worst;  and  it  is  desirable  not  to  put  stations  on 
magnesian  limestone  if  it  can  be  avoided. 

"  4.  The  Chalk. — The  chalk,  when  mixed  with  clay,  and 
permeable,  forms  a  very  healthy  soil.  The  air  is  pure,  and 
the  water,   though  charged  with  calcium  carbonate,  is  clear, 


156  TEXT-BOOK    OF    HYGIENE. 

sparkling,  and  pleasant.  Goitre  is  not  nearly  so  common,  nor 
apparently  calculus,  as  in  the  limestone  districts. 

"If  the  chalk  be  marly,  it  becomes  impermeable,  and  is 
then  often  damp  and  cold.  The  lower  parts  of  the  chalk,  which 
are  underlaid  by  gault  clay,  and  which  also  receive  the  drainage 
of  the  parts  above,  are  often  very  malarious;  and  in  America 
some  of  the  most  marshy  districts  are  in  the  chalk. 

"  5.  The  Sandstones. — The  permeable  sandstones  are  very 
healthy;  both  soil  and  air  are  dry;  the  drinking-water  is,  how- 
ever, sometimes  impure.  If  the  sand  be  mixed  with  much  clay, 
or  if  clay  underlies  a  shallow  sand-rock,  the  site  is  sometimes 
damp. 

"The  hard  millstone-grit  formations  are  very  healthy,  and 
their  conditions  resemble  those  of  granite. 

"6.  Gravels  of  any  depth  are  always  healthy,  except  when 
they  are  much. below  the  general  surface,  and  water  rises  through 
them.  Gravel  hillocks  are  the  healthiest  of  all  sites,  and  the 
water,  which  often  flows  out  in  springs  near  the  base,  being 
held  up  by  the  underlying  clay,  is  very  pure. 

"  7.  Sands. — There  are  both  healthy  and  unhealthy  sands. 
The  healthy  are  the  pure  sands,  which  contain  no  organic 
matter,  and  are  of  considerable  depth.  The  air  is  pure,  and  so 
is  often  the  drinking-water.  Sometimes  the  drinking-water  con- 
tains enough  iron  to  become  hard,  and  even  chalybeate.  The 
unhealthy  sands  are  those  which,  like  the  subsoil  of  the  Landes, 
in  southwest  France,  are  composed  of  silicious  particles  (and 
some  iron)  held  together  by  a  vegetable  sediment. 

"In  other  cases  sand  is  unhealthy  from  underlying  clay  or 
laterite  near  the  surface,  or  from  being  so  placed  that  water 
rises  through  its  permeable  soil  from  higher  levels.  Water  may 
then  be  found  within  3  or  4  feet  of  the  surface ;  and  in  this  case 
the  sand  is  unhealthy  and  often  malarious.  Impurities  are 
retained  in  it  and  effluvia  traverse  it. 

"In  a  third  class  of  cases  the  sands  are  unhealthy  because 
they  contain  soluble  mineral  matter.     Many  sands  (as,  for  ex- 


CHARACTER    OF    THE    SOIL.  157 

ample,  in  the  Punjab)  contain  magnesium  carbonate  and  lime- 
salts,  as  well  as  salts  of  the  alkalies.  The  drinking-water  may 
thus  contain  large  quantities  of  sodium  chloride,  sodium  carbon- 
ate, and  even  lime  and  magnesian  salts  and  iron.  Without 
examination  of  the  water  it  is  impossible  to  detect  these  points. 

"8.  Clay,  Dense  Marls,  and  Alluvial  Soils  Generally. — 
These  are  always  regarded  with  suspicion.  Water  neither  runs 
off  nor  runs  through;  the  air  is  moist;  marshes  are  common; 
the  composition  of  the  water  varies,  but  it  is  often  impure  with 
lime  and  soda  salts.  In  alluvial  soils  there  are  often  alterations 
of  thin  strata  of  sand,  and  sandy,  impermeable  clay.  Much 
vegetable  matter  is  often  mixed  with  this,  and  air  and  water  are 
both  impure. 

"  The  deltas  of  great  rivers  present  these  alluvial  characters 
in  the  highest  degree,  and  should  not  be  chosen  for  sites.  If 
they  must  be  taken,  only  the  most  thorough  drainage  can  make 
them  healthy.  It  is  astonishing,  however,  what  good  can  be 
effected  by  the  drainage  of  even  a  small  area,  quite  insufficient 
to  affect  the  general  atmosphere  of  the  place ;  this  shows  that  it 
is  the  local  dampness  and  the  effluvia  which  are  the  most 
hurtful. 

"9.  Cultivated  Soils. — Well-cultivated  soils  are  often 
healthy ;  nor  at  present  has  it  been  proved  that  the  use  of  manure 
is  hurtful.  Irrigated  lands,  and  especially  rice-fields,  which  not 
only  give  a  great  surface  for  evaporation,  but  also  send  up 
organic  matter  into  the  air,  are  hurtful.  In  Northern  Italy, 
where  there  is  a  very  perfect  system  of  irrigation,  the  rice- 
grounds  are  ordered  to  be  kept  14  kilometres  (8.7  miles)  from 
the  chief  cities,  9  kilometres  (5.6  miles)  from  the  lesser  cities  and 
the  forts,  and  1  kilometre  (1094  yards)  from  the  smaller  towns. 
In  the  rice  countries  of  India  [and  America]  this  point  should 
not  be  overlooked." 

Where  a  wet,  impermeable,  or  impure  soil  must,  of  neces- 
sity, be  chosen  as  a  building-site,  it  should  be  thoroughly 
drained.     The  minimum  depth  at  which  drains  are  laid  should 


158  TEXT-BOOK    OF   HYGIENE. 

be  not  less  than  1^  metres  below  the  floor  of  the  cellar  or  base- 
ment. Such  a  soil  should  be  covered  with  a  thick,  impervious 
layer  of  asphaltum  or  similar  cement  under  the  house,  in  order 
to  prevent  the  aspiration  of  the  polluted  ground-air  into  the 
building. 

It  is  a  frequent  custom  in  cities  to  fill  in  irregularities  of 
the  building-site  with  street-sweepings  and  garbage,  which 
always  contain  large  quantities  of  decomposing  organic  matters. 
This  is  a  gross  violation  of  the  plainest  principles  of  hygiene. 
It  is  almost  equally  reprehensible  to  use  such  decaying  or 
putrefying  organic  material  for  the  purpose  of  grading  streets 
or  sidewalks  in  cities  and  towns.1  It  should  be  the  constant 
endeavor  of  all  sanitary  authorities  to  prevent  pollution  of  the 
soil  as  much  as  possible  in  villages,  towns,  and  cities. 

Where  houses  are  built  on  the  declivity  of  a  hill,  the  upper 
wall  should  not  be  built  directly  against  the  ground,  as  it  would 
tend  to  keep  the  wall  damp.  A  vacant  space  should  be  left 
between  the  wall  and  the  ground  to  permit  free  access  of  air 
and  light. 

In  addition  to,  or  in  default  of,  drainage,  the  drying  of  soil 
can  be  promoted  by  rapidly-growing  plants,  which  absorb  water 
from  the  soil  and  give  it  out  to  the  air.  The  sunflower  and  the 
eucalyptus  tree  are  the  most  available  for  this  purpose. 


III. THE   MATERIAL   OF   WHICH   THE   HOUSE   IS   BUILT. 

The  nature  of  the  most  appropriate  building  material  de- 
pends upon  so  many  collateral  circumstances  that  definite  rules 
cannot  be  laid  down.  As  a  general  rule,  moderately  hard 
burned  brick  is  the  most  serviceable  and  available  material.  It 
is  easily  permeable  by  the  air,  and  so  permits  natural  ventila- 
tion through  the  walls,  unless  this  is  prevented  by  other  means. 

1  During  the  very  fatal  epidemic  of  yellow  fever  in  New  Orleans,  in  1878,  it  was  ascer- 
tained that  a  contractor  for  street-work  used  the  garbage  and  street-scrapings  to  grade  the  bed 
of  the  streets.  Even  though  in  this  case  it  may  not  have  intensified  the  epidemic  in  these 
localities,  the  practice  is  so  contrary  to  the  simplest  sanitary  laws  that  it  should  nowhere  be 
tolerated.  The  author  is  aware,  however,  that  the  "made-ground"  of  nearly  every  city  in  this 
country  is  composed  largely  of  just  such  material.  All  sanitarians  should  protest  against  a 
continuance  of  this  pernicious  practice. 


MATERIAL    OF    WHICH    THE    HOUSE    IS   BUILT.  159 

It  does  not  absorb  and  hold  water  readily ;  hence,  damp  walls 
are  infrequent  if  brick  is  used.  It  is  probably,  of  all  building 
material,  the  most  durable.  On  account  of  its  porosity  a  brick 
wall  is  a  poor  conductor  of  heat.  It  therefore  prevents  the 
rapid  cooling  of  a  room  in  cold  weather,  and  likewise  retards 
the  heating  of  the  inside  air  from  without  in  summer.  Another 
very  great  advantage  is  its  resistance  to  a  very  high  degree  of 
heat,  brick  being  probably  more  nearly  fire-proof  than  any 
other  building  material. 

In  hot  climates  light  wooden  buildings  are  advantageous, 
because  they  cool  off  very  rapidly  after  the  sun  has  disappeared. 
On  account  of  the  numerous  joints  and  fissures  in  a  frame 
building,  natural  ventilation  goes  on  very  readily  and  to  a  con- 
siderable extent. 

Next  to  brick,  granite,  marble,  and  sandstone  are  the  most 
serviceable  building  materials.  Very  porous  sandstone  is,  how- 
ever, not  very  durable  in  cold  climates,  as  the  stone  absorbs  large 
quantities  of  water,  which,  in  consequence  of  the  expansion 
accompanying  the  act  of  freezing,  produces  a  gradual  but 
'progressive  disintegration. 

The  application  of  paint  to  the  walls,  either  within  or  with- 
out, almost  completely  checks  the  transpiration  of  air  through 
the  walls,  thus  limiting  natural  ventilation.  Calcimining,  on 
the  other  hand,  offers  very  little  obstruction  to  the  passage  of 
air.  Wall-paper  is  about  midway  between  paint  and  lime- 
coating  in  its  obstructive  effect  on  atmospheric  transpiration. 

Newly-built  houses  should  not  be  occupied  until  the  walls 
have  become  dry.  Moisture  in  the  walls  is  probably  a  not 
infrequent  source  of  ill  health;  it  offers  favorable  conditions  for 
the  development  of  fungi  (possibly  of  disease-germs),  and,  by 
filling  up  the  pores  of  the.  material  of  which  the  walls  are 
composed,  prevents  the  free  transpiration  of  air  through 
them. 

Moisture  of  the  walls  is  sometimes  due  to  the  ascent  of 
the  water  from  the  soil  by  capillary  attraction.     This  can  be 


160  TEXT-BOOK   OF   HYGIENE. 

prevented  by  interposing  an  impervious  layer  of  slate  in  the 
foundation- wall. 

Where  the  moisture  is  due  to  the  rain  beating  against  the 
outside  walls,  and  thus  saturating  them  if  composed  of  porous 
materials,  a  thorough  external  coating  of  impervious  paint  will 
prove  a  good  remedy. 

IV. INTERIOR    ARRANGEMENTS. 

A.  Size  of  Rooms,  and  Ventilating  and  Heating  Arrange- 
ments.— The  rooms  in  dwelling-houses  should  never  be  under 
2h  metres  in  height  from  floor  to  ceiling.  In  sleeping-rooms 
the  initial  air-space  should  never  be  less  than  35  cubic  metres 
for  adults,  and  25  cubic  metres  for  children  under  10  years  of 
age.  Provision  must  be  made  for  changing  this  air  sufficiently 
often  to  maintain  it  at  its  standard  of  purity;  i.e.,  less  than  7 
parts  of  carbon  dioxide  per  10,000.  The  details  for  accomplish- 
ing this  will  vary  with  the  architects'  designs,  the  material  of 
which  the  house  is  constructed,  the  climate,  and  the  season. 
The  principles  laid  down  in  the  section  on  ventilation  (Chapter 
I)  should  be  adhered  to.  In  cold  weather  the  air  should  be 
warmed,  either  before  its  entrance  into  the  room  or  afterward,  by 
stove  or  fire-place.  Galton's  jacketed  stove,  or  fire-place,  seems 
to  answer  this  purpose  admirably.  The  details  of  the  heating 
apparatus  must  be  left  to  individual  taste,  or  other  circum- 
stances. It  may  be  noted,  however,  in  passing,  that  the  pre- 
vailing method  of  heating  houses  by  means  of  hot  air  is  objec- 
tionable for  various  reasons ;  partly,  because  the  air  is  usually  too 
dry  to  be  comfortable  to  the  respiratory  organs ;  partly,  because 
organic  matter  is  frequently  present  in  large  proportions,  and 
gives  the  air  an  offensive  odor  when  the  degree  of  heat  is  high 
enough  to  scorch  the  organic  matter.  Both  these  objections 
are,  however,  removable ;  the  first,  by  keeping  a  vessel  of  water 
constantly  in  the  furnace,  so  that  the  hot  air  can  take  up  a 
sufficient  proportion  of  vapor  in  passing  through,  and,  the  second, 
by  having  the  furnace  made  large  enough  so  that  the  tempera- 


INTERIOR    ARRANGEMENTS. 


161 


ture  need  never  be  raised  to  a  very  high  degree.  Heating  by 
hot  water  or  steam  is  preferable  to  the  hot-air  furnace.  Both 
of  these  methods  are,  however,  more  expensive. 

Where  special  ventilating  arrangements  are  necessary,  air- 


FiG.  6. 

a,  a,  sash :  b,  6,  window-jambs ;  c,  c,  window- 
sill.  This  cut  represents  the  view  from 
within  the  Bury  Ventilator,  in  operation. 
It  is  broken  away  at  one  end  to  show  the 
sash  raised  above  the  outer  holes  to  admit 
the  air. 


Fig.  7. 

a,  a,  sash.  This  cut  represents  the  view  from 
without  the  Bury  Ventilator,  in  operation. 
The  sash  is  broken  away  to  show  the  ven- 
tilator behind,  with  the  fresh  air  passing 
in. 


inlets  may  be  inserted  at  appropriate  points  in  the  walls  of  the 
room,  facing  toward  the  air.  A  simple  arrangement  is  that  known 
as  the  Bury  Ventilator,  shown  in  Figs.  6  and  7.  It  consists 
of  a  wooden  block  interposed  between  the  bottom  of  the  lower 


ii 


162 


TEXT-BOOK    OF   HYGIENE. 


window-sash  and  the  window-frame.  The  air  passes  into  the  room 
through  the  openings  in  the  block,  as  shown  in  the  illustration. 
The  separation  of  the  upper  and  lower  sashes,  when  the  ventilator 


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is  in  place,  also  adds  to  the  efficiency  of  the  ventilation,  as  the 
air  passes  in  through  the  space  so  formed. 

A  cheaper  ventilator  can  be  made  by  simply  tacking  a  strip 


INTERIOR    ARRANGEMENTS.  163 

of  canvas,  binders'  board,  or  manilla  paper,  20  to  25  centimetres 
wide,  across  the  lower  portion  of  the  window-frame,  and  then 
raising  the  sash  10  to  15  centimetres.  The  air  will  pass  in 
under  the  lower  and  between  the  lower  and  upper  sashes  and 
pass  upward  toward  the  ceiling  and  then  gradually  diffuse  itself 
through  the  room.  In  summer  a  counter-opening  may  be  ob- 
tained for  the  escape  of  foul  air  by  lowering  the  upper  sash, 
while  in  winter  a  stove  or  fire-place  will  furnish  a  good  exit. 

Fig.  8  shows  the  probable  course  of  the  air-currents  in  a 
room  ventilated  by  means  of  a  fresh-air  inlet  near  the  ceiling 
and  an  open  fire-place.  A  is  the  inlet ;  C  the  fire-place  ;  G  the 
floor ;  F,  ceiling ;   E  E,  flues. 

B.  Internal  Wall- Coating. — A  point  of  considerable  im- 
portance in  the  outfitting  of  dwelling-houses  is  the  material 
used  for  coating  or  decorating  the  inside  of  the  walls.  Green 
paint  and  green-colored  wall-papers  should  be  rejected.  The 
reason  for  avoiding  this  color  is  the  following  :  Bright-green 
pigments  and  dyes  are  largely  composed  of  some  compound  of 
arsenic,  which  becomes  detached  from  the  wall  or  paper  when 
dry.  and,  being  inhaled,  produces  a  train  of  symptoms  which 
have  been  recognized  as  chronic  arsenical  poisoning.  Many 
cases  have  been  reported  in  which  serious  and  even  fatal  poison- 
ing has  been  produced  in  this  way.1  It  would  be  advisable, 
therefore,  to  discard  all  bright-green  tints  in  paints  and  orna- 
mental paper-hangings. 

C.  Lighting. — Provision  should  be  made  in  all  dwelling- 
houses  for  an  abundant  supply  of  sunlight.  Every  room  should 
have  at  least  one  window  opening  directly  to  the  sun.  It  is  not 
sufficient  to  give  an  ample  window-space,  which  should  be  in 
the  proportion  of  one  to  five  or  six  of  floor-space,  but  the  im- 
mediate surroundings  of  the  house  must  be  taken  into  account. 
Thus,  close  proximity  of  other  buildings,  or  of  trees,  may  pre- 
vent sufficient  light  entering  a  room,  although   the  window- 

1  Arsenic  in  Certain  Green  Colors,  F.  W.  Draper.  Third  Annual  Report  Mass.  State 
Board  of  Health,  1S72,  pp.  18-57. 


164  TEXT-BOOK   OF   HYGIENE. 

space   may   be    in    excess    of    that   required    under    ordinary 
circumstances. 

Some  form  of  artificial  light  will  also  be  needed  in  all 
dwellings.  Certain  dangers  are  necessary  accompaniments  of 
all  available  methods  of  artificial  illumination.  The  danger 
from  fire  is,  of  course,  the  most  serious.  This  danger  is  prob- 
ably least  where  candles  are  used,  and  greatest  where  the  more 
volatile  oils  (kerosene,  gasolene)  are  employed.  The  use  of 
candles  results  in  pollution  of  the  air  by  carbon  dioxide  and 
other  products  of  combustion  to  a  greater  degree  than  when 
other  illuminating  agents  are  used ;  they  also  give  out  a  larger 
amount  of  heat  in  proportion  to  their  power  of  illumination. 
Kerosene  gives  a  good  light  when  burned  in  a  proper  lamp,  and 
is  cheap,  but  the  dangers  from  explosion  and  fire  are  consider- 
able. The  danger  from  explosion  can  be  greatly  reduced  by 
always  keeping  the  lamp  filled  nearly  to  the  top,  and  never  fill- 
ing it  near  a  light  or  fire.  The  danger  of  explosion  is  increased 
when  the  chimney  of  the  lamp  is  broken,  as  then  the  tempera- 
ture of  the  metal  .collar,  by  which  the  burner  is  fastened  to  the 
lamp,  is  rapidly  raised1  and  the  oil  vaporized.  If,  at  the  same 
time,  the  lamp  is  only  partially  filled  with  oil,  the  space  above  it 
is  occupied  by  an  explosive  mixture  of  air  and  the  vapor  of  the 
oil.  If  this  is  heated  to  a  sufficient  degree  an  explosion  will 
take  place.2 

The  use  of  coal-gas  is  probably  attended  by  less  danger 
than  the  lighter  oils,  but  by  more  than  other  means  of  illumina- 
tion. In  addition  to  the  dangers  from  fire  and  explosions,  which 
are  inevitable  accompaniments  of  defects  in  the  fixtures,  the 
escaping  gas  is  itself  exceedingly  poisonous  from  the  large 
amount  of  carbon  monoxide  it  contains.  It  is,  in  fact,  a  very 
frequent  occurrence  in  large  cities  that  persons  are  killed  by  the 
inhalation  of  gas  which  has  escaped  from  the  fixtures  or  was 


1  H.  B.  Baker,  in  Report  Mich.  State  Board  of  Health,  1876,  p.  48. 

2  See  an  instructive  paper  by  Prof.  B.  C.  Kedzie,  in  Report  Mich.  State  Board  of  Health 
for  1877,  p.  71  et  seq. 


INTERIOR    ARRANGEMENTS.  165 

allowed  to  escape  from  the  burner  through  ignorance.  That 
variety  of  illuminating  gas  known  as  "water-gas"  is  more  dan- 
gerous to  inhale  than  coal-gas  owing  to  the  larger  proportion  of 
carbon  monoxide  contained  in  it.  The  "natural  gas"  used  as  a 
fuel  and  illuminant  in  some  places  in  the  United  States  is  espe- 
cially dangerous  from  the  total  absence  of  odor.  The  gas  may 
escape  in  large  quantity  and  fail  to  give  notice  of  its  presence 
except  by  an  explosion,  if  ignited,  or  by  producing  asphyxia  in 
those  who  incautiously  venture  into  the  air  permeated  by  it. 

The  electric  light  (Edison's  incandescent  system)  is  prob- 
ably open  to  less  objection  on  the  score  of  danger  than  any 
other  of  the  illuminating  systems  mentioned.  There  is  no  trust- 
worthy evidence  that  the  electric  light  has  any  unfavorable  in- 
fluence on  the  vision,  although  Regnault  supposed  it  would  have 
a  bad  effect  upon  the  ocular  humors  on  account  of  the  large 
proportion  of  the  violet  and  ultra-violet  rays  it  contained.  In 
order  to  remove  this  objection  Bouchardat  advised  the  wearing 
of  yellow  glasses  by  those  compelled  to  use  this  light  for  close 
work.  The  advantages  of  the  incandescent  light,  besides  the 
brilliant  white  light  it  gives,  are  that  it  is  steady  and  does  not 
produce  any  heat,  nor  does  it  pollute  the  air  with  carbon  dioxide 
and  other  products  of  combustion.  Professor  von  Pettenkofer 
has  recently  shown  experimentally  that  the  pollution  of  the  air 
by  the  products  of  combustion  is  very  much  greater  when  gas 
is  used  than  where  the  electric  light  is  employed.  The  electric 
arc-lights  are  extremely  dangerous  on  account  of  the  high  poten- 
tial maintained  in  the  wires,  and  the  difficulty  of  thoroughly 
insulating  the  latter.  Many  deaths  have  occurred  from  this 
source,  and,  unless  a  method  is  discovered  and  adopted  by 
which  the  voltage  of  the  arc-light  current  can  be  greatly  dimin- 
ished without  decreasing  the  efficiency  of  the  light,  this  method 
of  lighting  must  soon  be  given  up  in  cities,  owing  to  its  danger, 
not  only  to  those  directly  brought  in  contact  with  the  conductors, 
but  to  others  who  may  indirectly  get  in  the  way  of  the  errant 
current. 


166  TEXT-BOOK    OF    HYGIENE. 

In  writing,  sewing,  reading,  or  other  work  requiring  a  con- 
stant use  of  accurate  vision,  the  light,  whether  natural  or  artifi- 
cial, should  fall  upon  the  object  from  above  and  on  the  left  side. 
Hence,  windows  and  burners  should  be  at  least  at  the  height 
of  the  shoulder  and  to  the  left  of  the  person  using  the  light. 

Increased  ventilation  facilities  must  be  provided  where  arti- 
ficial light  (except  the  electric  light)  is  used  to  any  extent.  It 
has  been  calculated  that  for  every  lighted  gas-burner  12  to  15 
cubic  metres  of  fresh  air  per  hour  must  be  furnished  in  addition 
to  the  amount  ordinarily  required  in  order  to  maintain  the  air 
of  the  room  at  the  standard  of  purity. 

V. WATER-SUPPLY. 

The  water-supply  of  a  dwelling-house  should  be  plentiful  for 
all  requirements,  and  its  distribution  should  be  so  arranged  that 
the  supply  for  every  room  is  easily  accessible.  "Where  prac- 
ticable, water-taps  should  be  placed  on  every  floor,  both  for 
convenience  and  for  greater  safety  in  case  of  fire.  It  is  also  a 
result  of  observation  that  personal  habits  of  cleanliness  increase 
in  a  direct  ratio  with  the  ease  of  obtaining  the  cleansing  a°:ent. 
The  inmates  of  a  house  where  water  is  obtainable  with  little 
exertion  are  much  more  likely  to  be  cleanly  in  habits  than 
where  the  water-supply  is  deficient  or  not  readily  procured. 

VI. — HOUSE-DRAINAGE. 

Provision  must  be  made  for  the  rapid  and  thorough  removal 
of  waste-water  and  excrementitious  substances  from  the  house. 
This  is  most  easily  and  completely  accomplished  by  well-con- 
structed water-closets  and  sinks.  Water-closets  should,  however, 
not  be  tolerated  in  any  room  occupied  as  a  living-  or  bed-  room. 
It  would  doubtless  be  very  much  more  in  accordance  with  sani- 
tary requirements  to  have  all  permanent  water-fixtures,  water- 
closets,  and  bathing  arrangements  placed  in  an  annex  to  the 
dwelling  proper.  In  this  way  the  most  serious  danger  from 
water-closets  and  all  arrangements  having  a  connection  with  a 


HOUSE-DRAINAGE.  167 

cess-pool  or  common  sewer — permeation  of  the  house  by  sewer- 
air — could  be  avoided. 

Water-closets,  however,  presuppose  an  abundant  supply  of 
water.  Unless  this  can  be  obtained  and  rendered  available  for 
flushing  the  closets,  soil-pipe,  and  house-drain,  the  dry-earth  or 
pail  system  should  be  adopted.  Privies  should  not  be  coun- 
tenanced. Experience  in  several  large  cities  of  Europe  has 
demonstrated1  that  the  pail  system  can  be  adopted  with  advan- 
tage and  satisfactorily  managed  even  in  large  communities. 

As  house-drainage  may  be  considered  the  first  and  most 
important  link  in  a  good  sewerage  system,  a  brief  description 
will  be  here  given  of  the  details  of  the  drainage  arrangements 
of  a  dwelling-house.  The  rapid  and  complete  removal  of  all 
faecal  and  urinary  discharges,  lavatory-  and  bath-  wastes,  and 
kitchen-slops  must  be  provided  for.  For  these  purposes  are 
needed,  first,  water-closets  and  urinals,  wash-basins  and  bath- 
tubs, and  kitchen-  or  slop-  sinks ;  second,  a  perpendicular  pipe, 
with  which  the  foregoing  are  connected,  termed  the  soil-pipe; 
and,  third,  a  horizontal  pipe,  or  house-drain,  connecting  with  the 
common  cess-pool  or  sewer. 

A.  Water-Closets — There  are  five  classes  of  water-closets 
in  general  use.  They  are  the  pan-,  valve-,  plunger-,  hopper-,  and 
washout-  closets. 

Pan-closets  are  those  found  in  most  old  houses  containing 
water-closet  fixtures.  Just  under  the  bowl  of  the  closet  is  a 
shallow  pan  containing  a  little  water,  in  which  the  dejections 
are  received.  On  raising  the  handle  of  the  closet,  the  pan  is 
tilted  and  the  water  at  the  same  time  is  turned  on,  which  washes 
out  the  excrement  and  sends  it  into  or  through  the  trap  between 
the  closet  and  the  soil-pipe.  It  will  be  readily  understood  that 
the  space  required  for  the  movement  of  the  pan — the  "  container," 
as  it  is  termed — is  rarely  thoroughly  cleansed  by  the  passage  of 
water  through  it.  Feecal  matter,  paper,  etc.,  gradually  accumu- 
late in  the  corners  of  the  container,  and,  as  a  consequence,  pan- 

1  See  Chapter  v,  p.  139. 


168  TEXT-BOOK   OF   HYGIENE. 

closets  are  always,  after  a  brief  period  of  use,  foul.  There  are 
other  defects  in  the  construction  of  the  pan-closet  which  render 
it  untrustworthy,  but  the  one  especially  pointed  out — the  impos- 
sibility of  keeping  it  clean — is  enough  to  absolutely  condemn  its 
use,  from  a  sanitary  point  of  view.  It  is  decidedly  the  worst 
form  of  closet  that  can  be  used. 

Valve-closets  are  merely  modifications  of  the  pan-closet. 
The  bottom  of  the  bowl  is  closed  by  a  flat  valve,  which  is  held 
in  its  place  by  a  weight.  By  moving  a  lever  the  valve  is  turned 
down,  allowing  the  excreta  to  drop  into  the  container.  The  only 
differences  between  the  pan-  and  valve-  closets  are  that  in  the 
latter  a  flat  valve  is  substituted  for  the  pan  of  the  former,  and 
that  this  allows  the  container  to  be  made  smaller.  Otherwise, 
there  are  no  advantages  in  the  valve-closet.  Considered  from  a 
sanitary  stand-point,  the  valve-closet  is  no  worse  than  the  pan- 
closet,  and  but  very  little,  if  any,  better. 

The  third  variety,  or  plunger-closet,  has  several  marked 
advantages  over  the  two  just  described.  The  characteristic 
feature  of  the  closets  of  this  class  is  that  the  outlet,  which  is 
generally  on  one  side  of  the  bowl,  is  closed  by  a  plunger.  This 
bowl  is  always  from  one- third  to  one-half  full  of  water,  into  which 
the  excreta  fall.  On  raising  the  plunger,  the  entire  contents  of 
the  bowl  are  rapidly  swept  out  of  the  apparatus  into  the  soil- 
pipe,  the  bowl  thoroughly  washed  out  by  a  sudden  discharge  of 
water,  and,  on  closing  the  outlet  with  the  plunger,  the  bowl  is 
again  partly  filled  with  water.  An  overflow  attachment  prevents 
accumulation  of  too  large  a  quantity  of  water  in  the  bowl.  This 
overflow,  however,  sometimes  becomes  very  foul  and  objection- 
able. The  Jennings,  Demarest,  and  Hygeia  are  types  of  this 
class.  The  principal  objection  is  that  the  plunger  sometimes 
fails  to  properly  close  the  outlet,  allowing  the  water  to  drain  out 
of  the  bowl,  and  thus  destroying  one  of  its  principal  advantages. 
The  mechanism  is  also  somewhat  complicated  and  likely  to  get 
out  of  order. 

The  hopper-closet  consists  of  a  deep  earthenware  or  enameled 


HOUSE-DRAINAGE. 


169 


iron  bowl,  with  a  water-seal  trap  directly  underneath.  The 
excreta  are  received  directly  into  the  proximal  end  of  the  trap, 
and  when  the  water  is  turned  on  the  sides  of  the  bowl  are 
washed  clean  and  everything  in  the  bowl  and  trap  swept  directly 
into  the  soil-pipe.  There  is  no  complicated  mechanism  to  get 
out  of  order,  the  trap  is  always  in  sight,  and  the  entire  appa- 
ratus can  always  be  kept  clean  and  inoffensive,  as  there  are  no 
hidden  corners  or  angles  for  filth  to  lodge.  This  form  of  closet 
is,  all  things  considered,  one  of  the  best  for  general  use. 


Fig.  9.— The  "Dececo"  Closet.    (New  Form.) 


The  "  wash-out "  closets  are  of  various  shapes,  some  having 
the  trap  in  the  bowl  itself,  others  having  a  double  water-trap. 
,  They  are  generally  simple  in  construction,  and  not  likely  to  get 
out  of  order.  They  do  not  present  any  decided  advantages  over 
the  simple  hopper,  although  at  the  present  time  they  are  more 
used  than  any  other  form  of  closet.  Of  the  recent  improvements 
in  this  form  of  closet  may  be  mentioned  the  "A.  G.  M.,"1  shown 

1  Manufactured  by  the  Myers  Sanitary  Depot,  New  York. 


170 


TEXT-BOOK   OF   HYGIENE. 


Fig.  10.— The  "A.  G.  M."  Closet. 


HOUSE-DRAINAGE. 


171 


in  view  with  cistern  in  Fig-.  10,  and  in  section  in  Fig.  11,  and 
the  "  Dececo,"  Fig.  9,  invented  by  Col.  George  E.  Waring. 
In  the  latter  the  automatic  siphon  principle,  so  ingeniously  used 
by  Rogers  Field  in  the  construction  of  the  automatic  flush-tank, 
is  applied  to  the  scouring  of  a  water-closet.  Practical  experi- 
ence for  six  or  seven  years  has  demonstrated  the  great  usefulness 
of  this  closet.  If  the  delivery  of  water  from  the  flushing-cistern 
is  properly  regulated,  at  first  rapid  to  thoroughly  wash  out  the 


Fig.  11.— Sectional  View  of  "A.  G.  M."  Closet. 


closet  and  connections,  and  then  slow  to  re-establish  the  proper 
depth  of  seal  in  the  trap,  the  closet  should  be  thoroughly  satis- 
factory in  its  working. 

Water-closets  should  not  be  inclosed  in  wooden  casings,  as 
is  almost  universally  done.  Everything  connected  with  the 
closet,  soil-  and  drain-  pipes,  water-supply,  and  all  joints  and  fix- 
tures should  be  exposed  to  view  so  that  the  defects  can  be  imme- 
diately seen  and  easily  corrected.  By  laying  the  floor  and  back 
of  the  closet  in  tiles  or  cement,  such  an  arrangement  can  even 


172  TEXT-BOOK   OF   HYGIENE. 

be  made  ornamental,  as  suggested  by  Waring,1  who  says  that  a 
closet  "  made  of  white  earthenware,  and  standing  as  a  white 
vase  in  a  floor  of  white  tiles,  the  back  and  side  walls  being 
similarly  tiled,  there  being  no  mechanism  of  any  kind  under 
the  seat,  is  not  only  most  cleanly  and  attractive  in  appearance, 
but  entirely  open  to  inspection  and  ventilation.  The  seat  for  this 
closet  is  simply  a  well-finished  hard-wood  board,  resting  on  cleats 
a  little  higher  than  the  top  of  the  vase,  and  hinged  so  that  it  may 
be  conveniently  turned  up,  exposing  the  closet  for  thorough 
cleansing,  or  for  use  as  a  urinal  or  slop-hopper." 

Where  the  arrangement  here  described  is  adopted,  extra 
urinals  are  unnecessary  and  undesirable.  Where  they  are  used 
they  should  be  constantly  and  freely  flushed  with  water,  other- 
wise they  become  very  offensive.  The  floor  of  the  urinal  should 
be  either  of  tiling  or  enameled  iron. 

B.  Water- Supply  for  Closets. — The  water-supply  for  flush- 
ing water-closets  should  not  be  taken  directly  from  the  common 
house-water  supply,  but  each  closet  should  have  an  independent 
cistern  large  enough  to  hold  a  sufficient  quantity  of  water  for  a 
thorough  flushing  (20  to  30  litres)  every  time  the  closet  is  used. 
The  objections  to  connecting  the  water-closet  directly  with  the 
common  house-supply  are,  that  there  is  often  too  little  head  of 
water  to  properly  flush  the  basin;  and,  secondly,  if  the  water 
be  drawn  from  a  fixture  in  the  lower  part  of  the  house,  while 
the  valve  of  a  water-closet  in  an  upper  floor  is  open  at  the  same 
time,  the  water  will  not  flow  in  the  latter  (unless  the  supply- 
pipe  is  very  large),  but  the  foul  air  from  the  closet  will  enter 
the  water-pipe,  and  may  thus  produce  dangerous  fouling  of  the 
drinking-water.  Hence,  separate  cisterns  for  each  water-closet 
should  always  be  insisted  upon. 

The  arrangement  of  these  cisterns  is  often  difficult  to  com- 
prehend. Fig.  12  shows  the  interior  arrangement  of  one  form. 
The  ball-shaped  float,  a,  cuts  off  the  supply  when  the  tank  is 
full,  while  opening  the  valve,  h,  by  means  of  the  crank,  c,  dis- 

*  Sanitary  Condition  of  New  York  City,  Scribner's  Monthly,  vol.  xxii,  No  2,  June,  1881. 


HOUSE-DRAINAGE. 


173 


charges 


contains  enough 


the  water.     The  rounded  annex,  cl 
water  to  partly  fill  the  closet-bowl  and  trap  after  the  contents 
have  been  washed  out  by  the  rapid  flush. 

C.  Traps. — Every  water-closet,  urinal,  wash-basin,  bath- 
tub, and  kitchen-sink  should  have  an  appropriate  trap  between 
the  fixture  and  the  soil-pipe.  The  trap  should  be  placed  as 
near  the  fixture  as  practicable,  as  pointed  out  above;  in  the 
best  forms  of  water-closet  the  bottom  of  the  closet  itself  forms 
part  of  the  trap. 


Fig.  12.— Flushing  Cistern  foe  Water-Ulosets. 


Traps  differ  in  shape  and  mechanism.  The  simplest  and 
usually  efficient  is  the  ordinary  S-trap  (Fig.  13).  This  trap  is 
of  uniform  diameter  throughout,  and  has  no  angles  for  the  lodg- 
ment of  filth.  A  free  flush  of  water  cleanses  it  perfectly,  and 
it  rarely  fails  to  furnish  a  sufficient  obstruction  to  the  passage 
of  sewer-air  from  the  soil-pipe,  unless  the  water  has  evaporated, 
or  been  forced  out  under  a  back-pressure  of  air  in  the  soil-pipe, 
or  been  siphoned  out,  and  thus  the  seal  broken. 


174  TEXT-BOOK   OF    HYGIENE. 

The  D-trap  and  bottle-trap  are  objectionable  on  account 
of  the  great  liability  of  becoming  fouled  by  filth  lodging  in  the 
corners,  while  in  the  mechanical  traps,  like  Bowers'  ball-valve 
trap.  Cudell's  trap,  and  others  of  this  class,  there  is  always 
danger  of  insufficient  seal  by  filth  adhering  to  the  valve,  and 
thus  preventing  its  exact  closure. 

Most  of  the  traps  now  furnished  by  the  dealers  in  plumbers' 
supplies  have  an  opening  in  the  highest  part  for  attaching  a 
vent-pipe.  It  has  been  found  that  the  seal  in  most  traps  can  be 
broken  by  siphonage,  if  the  pressure  of  air  on  the  distal  side 
(the  side  toward  the  soil-pipe)  of  the  trap  is  diminished,  or,  on 
the  other  hand,  by  increase  of  pressure  in  the  soil-pipe  the 
water  in  the  trap  may  be  forced  back  into  the  fixture,  and  thus 
sewer-air  enter  the  room.  By  providing  for  a 
free  entrance  and  exit  of  air  to  the  trap  this 
y^^s.  breaking  of  the  seal  can  be  prevented.  The 
/    /"">  ventilation  of  traps  is,  however,  an  evil,  as  it 

furnishes  an  additional  means  of  evaporation, 
and  when  the  fixture  is  not  in  frequent  (daily) 
use  the  seal  is  sooner  broken.  The  elaborate 
extra  system  of  ventilation  of  traps,  so  generally 
insisted  upon  by  plumbers  and  sanitary  engineers,  is  unnecessary. 
If  the  soil-pipe  is  of  the  proper  size  and  height,  siphonage  of 
traps  will  not  be  likely  to  occur.  The  waste-pipe  connecting 
the  fixture  and  the  soil-pipe  should  be  as  short  as  possible;  in 
other  words,  all  water-closets,  urinals,  baths,  and  lavatories 
should  be  placed  as  near  the  soil-pipe  as  practicable,  in  order  to 
have  no  long  reaches  of  foul  waste-pipe  under  floors  or  in 
rooms. 

Dr.  E.  S.  McClellan  has  recently  invented  a  trap  which 
obviates  many  of  the  objections  urged  against  all  previous  de- 
vices, and  is  intended  to  meet  the  defects  of  the  S  and  other 
traps.  It  consists  of  a  body  containing  a  light,  inverted  cup,  with 
its  edges  resting  in  an  annular  groove  containing  mercury,  which 
forms  an  absolute  seal  against  the  escape  of  sewer-air.     When 


w 


Fig.  13.— S-Trap. 


HOUSE-DRAINAGE. 


175 


a  slight  diminution  of  pressure  occurs  on  the  sewer  side  of  the 
cup,  the  greater  external  pressure  lifts  the  cup  out  of  the 
mercury  and  permits  a  free  inflow  of  air  until  the  wonted 
equilibrium  is  re-established,  when  the  cup  drops  back  into  the 
mercury  by  gravity,  and  effectually  closes  the  trap  against  any 
outflow.  With  this  trap  siphonage  of  the  seal  is  impossible. 
Fig.  14  shows  this  trap  with  the  cup  down,  and  Fig.  15  with 
the  cup  raised,  allowing  inflow  of  air. 

For  an  ordinary  wash-bowl  or  bath-waste  (which  should 


Fig.  14.— Section  al  View  of  Vent,  with 
Cup  in  Normal  Position. 


Fig.  15.— Sectional  View  op  Vent,  with 
Cup  Lifted  Out  of  the  Mercury 
by  the  Inflowing  Current  of  Air 
Indicated  by  the  Arrows. 


always  be  trapped),  the  Connolly  globe-trap,  shown  in  Figs.  16 
and  17,  is  an  excellent  fixture.  It  is  impossible,  under  ordinary 
circumstances,  to  break  the  seal  by  siphonage. 

D.  The  Soil-Pipe. — The  vertical  pipe  connecting  the 
water-closets  and  other  fixtures  with  the  house-drain  is  called 
the  soil-pipe.  It  should  be  of  iron,  securely  jointed,  of  an  equal 
diameter  (usually  10  centimetres)  throughout,  and  extend  from 
the  house-drain  to  from  1|  to  2  metres  above  the  highest  point 
of  the  house.  The  connections  of  all  the  waste-pipes  from 
water-closets,  baths,  etc.,  should  be  at  an  acute  angle,  in  order 


176 


TEXT-BOOK   OF    HYGIENE. 


that  an  inflow  at  or  nearly  at  right  angles  may  not  produce  an 
obstruction  in  the  free  passage  of  air  up  and  down  the  soil-pipe. 
The  diameter  of  the  soil-pipe,  at  its  free  upper  end,  should  not 
be  narrowed;  in  fact,  according  to  Col.  Geo.  E.  Waring,  the 
up-draught  is  rendered  more  decided  if  the  upper  extremity  of 
the  soil-pipe  is  widened.1  The  internal  surface  of  the  pipe 
should  be  smooth,  and  especial  care  should  be  taken  to  prevent 
projections  inward  at  the  joints;    otherwise,  paper  and  other 


Fig.  18.— Costxolly  Globe-Trap. 


Fig.  17.— Globe-Trap  Attached  to  Basin. 


matters  will  adhere  to  the  projections,  and  gradually  obstruct 
the  pipe. 

E.  The  House-Drain. — The  horizontal  or  slightly  inclined 
pipe  which  connects  the  lower  end  of  the  soil-pipe  with  the 
sewer  or  cess-pool,  the  point  of  final  discharge  from  the  house, 
should  be  of  the  same  diameter  and  material  as  the  soil-pipe. 
The  joints  should  be  made  with  equal  care,  and  the  pipe  should 
be  exposed  to  view  throughout  while  within  the  house-walls. 

1  Am.  Architect,  p.  12i,  Sept.  15,  1883. 


HOUSE-DRAINAGE.  177 

If  sunk  below  the  floor  of  the  cellar  it  should  be  laid  in  a 
covered  trench,  so  that  it  may  be  readily  inspected.  The  junc- 
tion between  the  vertical  and  horizontal  pipe  should  not  be  at  a 
right  angle,  but  the  angle  should  be  rounded.  The  drain-pipe 
should  not  be  trapped.  This  is  contrary  to  the  advice  of  sanitary 
authorities  generally,  but  the  author  thinks  it  unadvisable  to  trap 
the  drain-pipe.  There  should  be  no  obstruction  to  the  outflow 
of  sewage  from  the  house,  and  a  trap  in  the  drain-pipe  is  of  no 
avail  against  the  passage  of  sewer-air  from  the  sewer  or  cess- 
pool into  the  soil-pipe,  if  the  pressure  of  the  air  in  the  former 
is  increased.  Furthermore,  if  the  passage  of  air  backward  and 
forward  between  the  sewer  and  the  external  air  at  a  sufficient 
height  (above  the  roofs  of  houses,  for  example)  is  free  and 
unobstructed,  the  sewers  (or  the  cess-pool,  as  the  case  may  be) 
will  be  better  ventilated  than  if  an  obstruction  to  such  free 
circulation,  in  the  form  of  a  trap,  be  placed  in  the  drain-pipe. 

Nearly  all  sanitary  authorities  direct  that  an  opening  for 
the  admission  of  fresh  air — "fresh-air  inlet" — should  be  made 
in  the  drain-pipe,  before  its  connection  with  the  sewer  or  cess- 
pool. This  is  done  with  the  view  of  having  a  constant  current 
of  fresh  air  entering  near  the  base  of  the  soil-pipe  and  passing 
upward  through  it.  Theoretically  the  current  ought  always  to 
pass  in  this  direction.  Practically,  however,  the  current  is 
found,  at  times,  to  pass  the  other  way,  and  the  foul  air  from  the 
soil-pipe  may  be  discharged  into  the  air  near  the  ground,  where 
it  would  be  much  more  likely  to  do  harm  than  when  discharged 
high  up  in  the  air  beyond  the  possibility  of  being  breathed. 

OFFICIAL    SUPERVISION    OF    THE    SANITARY   ARRANGEMENTS   OF 

DWELLINGS. 

In  most  cities  and  towns  the  municipal  authorities  have 
provided  for  an  official  inspection  of  buildings,  to  prevent  neglect 
of  precautions  against  fire  and  other  manifest  dangers  to  life. 
It  is  only  very  recently,  however,  that  the  authorities  of  some 
of  the  larger  cities  in  this  country  have  enacted  laws  to  prevent 

12 


178  TEXT-BOOK   OF    HYGIENE. 

improper  construction  of  house-drainage  works.  Although  none 
of  these  laws  or  ordinances  cover  the  subject  completely,  yet 
their  proper  enforcement  must  result  in  great  advantage. 

Within  the  past  few  years,  following  the  example  of  Edin- 
burgh, volunteer  associations  have  been  organized  in  various 
cities  of  this  country,  with  the  object  of  securing  constant  expert 
inspection  and  supervision  of  the  drainage  arrangements  of 
dwellings  and  other  necessary  sanitary  improvements. 

The  good  results  accomplished  by  the  Newport  Sanitary 
Protection  Society,  the  New  Orleans  Auxiliary  Sanitary  Associa- 
tion, and  other  similar  bodies  attest  the  usefulness  of  such 
organizations. 

[The  following  works  are  recommended  to  the  student 
who  desires  a  fuller  knowledge  on  the  subjects  treated  in  this 
chapter : — 

W.  H.  Corfield,  Dwelling-Houses,  Their  Sanitary  Construction  and 
Arrangements,  N.  Y.,  1880. — Win.  Paul  Gerhard,  House-Drainage  and 
Sanitary  Plumbing,  Fourth  Report  State  Board  of  Health  of  R.  L, 
1881. — Eliot  C.  Clarke,  Common  Defects  in  House-Drains,  Tenth  Annual 
Report  Mass.  State  Board  of  Health,  187  9. J 


CHAPTER  VII. 

Construction  of   Hospitals. 

SITE. 

If  the  choice  of  a  site  for  the  habitations  of  healthy  per- 
sons is  a  matter  of  vital  importance,  as  was  pointed  out  in  the 
last  chapter,  it  needs  no  argument  to  impress  upon  the  reader 
the  actual  necessity  of  choosing  a  site  with  wholesome  surround- 
ings for  a  habitation  for  the  sick.  In  selecting  a  site  for  a  hos- 
pital, therefore,  it  is  of  prime  importance  to  avoid  a  location 
where  unsanitary  influences  prevail. 

While  a  hospital  should  always  be  easily  accessible,  it  is 
not  desirable  that  it  should  be  in  a  noisy  or  crowded  part  of  a 
city.  Where  a  hospital  is  primarily  designed  for  the  reception 
of  accident  or  "  emergency  "  cases,  it  is,  of  course,  necessary  to 
have  it  near  to  where  accidents  are  likely  to  occur.  In  a  city 
this  will  probably  be  in  the  most  crowded  and  noisy  part. 

The  direction  of  the  prevailing  winds  from  the  city  should 
be  avoided  in  selecting  a  site  for  a  hospital. 

Free  admission  of  sunlight  and  air  must  be  secured  to  all 
parts  of  the  hospital.  An  elevated  location  is  therefore  desir- 
able, although  exposure  to  violent  winds  must,  if  possible,  be 
avoided. 

The  soil  upon  which  a  hospital  is  built  should  be  clean, 
easily  drained,  with  a  deep-ground  water-level,  not  liable  to 
sudden  oscillations.  The  neighborhood  of  a  marshy  or  known 
malarious  region  should  be  avoided. 

THE   BUILDINGS, 

The  building  area  must  be  large*  enough  to  permit  the 
construction  of  buildings  in  accordance  with  the  modern  recog-- 
nized  principles  of  hospital  construction.     Overcrowding  is  not 

(179) 


180  TEXT-BOOK   OF   HYGIENE. 

permissible,  either  of  the  grounds  by  buildings  or  of  the  build- 
ings by  patients. 

Having  determined  the  number  of  patients  for  whom  pro- 
vision is  to  be  made  and  the  character  of  the  diseases  to  be 
treated,  an  estimate  must  be  made  of  the  area  necessary  for  a 
hospital.  Taking  into  account  all  the  buildings  needed,  the 
area  required  will  be — for  two  or  more  storied  buildings — not 
less  than  30  square  metres  per  bed.  If  one-story  buildings 
are  to  be  erected  more  space  will  be  required,  and  if  infectious 
diseases  are  to  be  treated  in  the  hospital  the  above  space-allowance 
must  be  doubled  or  trebled.  In  the  new  Johns  Hopkins  Hos- 
pital, in  Baltimore,  the  area  occupied  by  the  buildings  is  56,000 
square  metres,  and  provision  is  to  be  made  for  300  patients. 
This,  covering,  of  course,  the  area  occupied  by  the  administra- 
tion building,  nurses'  home,  kitchen,  dispensary,  operating  and 
autopsy  theatre,  laundry,  etc.,  gives  an  area  of  187  square  metres 
per  bed.  The  actual  allowance  of  floor  space  per  bed  is  11|- 
square  metres ;  for  patients  with  infectious  diseases  the  space- 
allowance  is  nearly  treble,  being  29  square  metres. 

Within  recent  years  the  principles  of  hospital  construction 
have  undergone  considerable  modification.  While  formerly 
a  large  hospital  consisted  usually  of  one  large,  two  or  more 
storied  building,  in  which  all  the  various  departments  were 
comprised  under  one  roof,  the  aim  has  recently  been  to  scatter 
the  wards  as  much  as  practicable  consistent  with  reasonable  ease 
of  supervision  and  administration.  Under  the  former  plan,  with 
large  wards  connected  by  common  corridors  and  stairways,  ease 
of  administration  was  primarily  secured ;  in  the  latter,  the 
most  important  object  of  a  hospital,  "  a  place  for  the  sick  to  get 
well  in,"  is  more  nearly  attained.  While  many  hospitals  are 
still  being  constructed  on  the  old  plan,  of  a  single  block  of 
several  stories  in  height,  nearly  all  sanitary  authorities  are 
agreed  that  the  plan  of  separate  pavilions  of  one  or,  at  most, 
two  stories,  in  which  the  buildings  are  entirely  disconnected,  or 
connected  only  by  means  of  an  open  corridor  for  convenience  of 


THE    HOSPITAL    BUILDINGS.  181 

administration,    is  best   for  the    patients,  and,  leaving  out  of 
account  the  cost  of  the  ground,  is  also  the  most  economical. 

The  recent  development  of  the  pavilion  system  of  hospitals 
may  be  attributed  largely  to  the  success  obtained  in  treating  the 
sick  and  wounded  in  the  simple  barrack  hospitals  during  the 
late  war  between  the  States.  The  army  barrack  hospital  is  the 
original  type  of  the  pavilion  hospital  of  the  present  day. 

Each  pavilion  consists  of  one  or  two  wards,  containing 
from  ten  to  thirty  beds  altogether.  In  each  pavilion  or  ward  is 
also  a  bath-  and  wash-  room,  water-closet,  dining-room,  scullery, 
attendants'  room,  and  sometimes  a  day-room  for  patients  able 
to  be  out  of  bed. 

The  two-story  pavilion  is  built  on  the  same  plan,  and  is 
generally  adopted  in  cities,  or  where  economy  of  space  is  desir- 
able for  financial  reasons,  and  where  no  infectious  diseases  are 
treated.  Where  practicable,  one-story  pavilions  should  always 
be  adopted,  as  they  are  more  easily  heated,  ventilated,  and 
served  than  two-storied  buildings. 

When  a  number  of  pavilions  or  wards  are  connected  by  a 
corridor  with  each  other,  and  with  a  central  or  administration 
building  and  other  service  buildings,  the  aggregation  constitutes 
a  modern  pavilion  block-hospital.  The  Johns  Hopkins  Hos- 
pital, already  referred  to,  is  a  model  hospital  of  this  class,  and 
its  plans  should  be  studied  in  detail  by  all  who  are  more  par- 
ticularly interested  in  hospital  construction.  The  general  wards 
are  in  one-  and  two-  story  buildings,  connected  by  a  corridor  with 
each  other  and  with  the  administration  and  service  buildings. 
In  addition  to  two  buildings  containing  private  rooms  and  small 
wards  for  patients  able  to  pay  for  the  extra  accommodations, 
there  is  a  line  of  pavilions  running  from  east  to  west.  The 
corridor  cuts  all  the  pavilions  near  the  north  ends  of  the  build- 
ings, separating  the  ward  almost  entirely  from  the  service  part 
of  the  building.  This  arrangement  leaves  the  south,  east,  and 
west  fronts  of  the  wards  entirely  exposed  to  the  sun's  rays, — 
a  very  important  advantage.     The  kitchen  and  laundry  are  at 


182 


TEXT-BOOK    OF   HYGIENE. 


opposite  angles  of  the  grounds,  while  the  autopsy  building  is 
placed  in  the  extreme  northeast  corner  of  the  grounds,  as  far 
from  all  the  wards  as  practicable. 

The  free  space  between  the  separate  pavilions  should  be  at 


WOLFE  ST. 


BROAfcVyAY 


Fig.  18.— Plan  of  Johns  Hopkins  Hospital. 

A.  Administration  Building.  B.  Female  Pay-Ward.  C.  Male  Pay-Ward.  D.  Male  Surgical  Ward. 
E.  Female  Surgical  Ward.  F.  Male  Medical  Ward.  G.  Female  Medical  Ward.  H.  Gynaecological 
Ward.  I.  Isolating  Ward.  K.  Kitchen.  L.  Laundry.  N.  Nurses'  Home.  O.  Dispensary.  R.  Patho- 
logical Building.    S.  Stable.    U.  Amphitheatre.    X.  Apothecary's  Building.    Y.Bath-House. 


least  twice  the  height  of  the  building.  In  the  Johns  Hopkins 
Hospital,  the  space  is  18  metres  between  the  one-story  common 
wards,  which  are  11  metres  in  height  from  the  surface  of  the 
ground  to  the  ridge  of  the  roof. 


VENTILATION    AND    HEATING.  183 

VENTILATION    AND    HEATING. 

The  cubic  space  (initial  air-space)  per  bed  in  the  wards 
should  not  be  less  than  1500  to  2000  cubic  feet  (42  to  56  cubic 
metres),  and  for  surgical  or  lying-in  cases  and  contagious  dis- 
eases, 70  cubic  metres  should  be  allowed.  The  ventilating 
arrangements  should  secure  an  entire  change  of  the  air  two  to 
three  times  in  an  hour. 

In  most  sections  of  the  United  States,  natural  ventilation 
can  be  relied  on  to  keep  the  air  in  hospital  wards  pure  (assum- 
ing, of  course,  the  proper  construction  of  the  buildings).  The 
windows,  doors,  and  walls  are  important  factors  in  securing  this 
ventilation.  Hence,  especial  care  is  to  be  paid  to  their  con- 
struction and  arrangement. 

Many  German,  French,  and  English  authorities  on  hospital 
building  urge  the  importance  of  making  the  walls  impervious 
by  cement,  glass,  or  paint.  The  peculiar  odor  known  as  "  hos- 
pital odor,"  it  is  asserted,  cannot  be  prevented  in  any  hospital 
in  which  the  floors,  walls,  and  ceilings  are  not  absolutely  imper- 
vious. The  American  practice  is  generally  in  favor  of  walls 
which  permit  transpiration  of  air.  In  the  experience  of  the 
author  the  imperviousness  of  the  walls  is  not  necessary  to  secure 
freedom  from  hospital  odor.  It  remains  a  question  for  serious 
consideration  whether  the  diminution  of  natural  ventilation 
would  not  counterbalance  any  good  resulting  from  non-absorp- 
tive walls. 

The  interior  of  the  walls  should  be  perfectly  smooth  and 
plain;  no  projections,  cornices,  or  offsets  of  any  kind  are  per- 
missible. The  desirability  of  this  restriction  was  clearly  ex- 
pressed nearly  a  hundred  years  ago  by  John  Howard:  "From 
a  regard  to  the  health  of  the  patients,  I  wish  to  see  plain,  white 
walls  in  hospitals,  and  no  article  of  ornamental  furniture  intro- 
duced."1 

Windows  should  run  quite  to  the  ceiling,  and  should  not 
be  arched,  but  finished  square  at  the  top.     There  should  be  one 

1  An  Account  of  the  Principal  Lazarettos  of  Europe,  etc.,  p.  57.    London,  1791. 


184  TEXT-BOOK    OF   HYGIENE. 

window  for  every  two  beds.  The  window-sash  should  be  double 
to  retain  heat,  and  the  lights  heavy,  clear  glass.  Ventilation 
can  be  promoted  by  raising  the  outer  sash  from  below  and 
lowering  the  inner  one  from  above.  The  insertion  of  a  Sher- 
ringham  ventilator  at  the  top  of  the  inner  sash  will  aid  in  giving 
the  incoming  air-current  an  upward  direction. 

Heating  is  best  accomplished  by  introducing  hot  air  from 
without,  or  by  stoves  or  fire-places  in  the  centre  of  the  wards. 
Where  hot  air  is  introduced  from  without,  it  should  be  heated 
by  passing  it  over  steam-  or  hot-  water  coils,  and  not  by  passing 
it  through  a  furnace,  which  may  produce  super-heating  and 
excessive  dryness  of  the  air. 

In  a  series  of  experiments  by  Dr.  Edward  Cowles  at  the 
Boston  City  Hospital,1  the  air  was  heated  to  32°  by  passing  it 
over  steam-coils.  It  was  admitted  to  the  wards  by  numerous 
inlets  30  centimetres  square.  The  best  velocity  for  ventilating 
and  warming  purposes  was  found  to  be  54  metres  per  minute. 
Exit  openings  were  in  the  ceiling,  and  it  was  found  best  to 
make  them  large,  as  by  this  means  the  rapidity  of  exit  currents 
is  reduced. 

Where  the  warming  of  the  ward  must  be  accomplished  by 
stoves  or  fire-places  in  the  ward,  the  best  plan,  for  square  and 
octagon  wards,  is  to  have  a  large  central  chimney  with  arrange- 
ments on  the  four  sides  for  fire-places  or  stoves.  This  chimney 
can  also  be  used  as  a  very  efficient  ventilating  shaft  throughout 
the  year  by  a  device  put  in  practice  by  Mr.  John  R.  Neimsee, 
architect  of  the  Johns  Hopkins  Hospital.2  In  oblong  wards, 
two  or  more  large  stoves,  placed  at  equal  distances  along  the 
centre  of  the  wards,  will  heat  the  wards  effectually. 

Floors  should  be  made  of  tiles,  slate,  or  oak  or  yellow-pine 
lumber.  If  wood  is  used,  it  should  be  well  seasoned,  perfectly 
smooth,  and  all  joints  accurately  made.  The  floor  should  be 
kept  constantly  waxed  to  render  it  impervious  to  fluids. 

1  Report  of  the  Massachusetts  State  Board  of  Health  for  1879,  pp.  231-248. 
a  Hospital  Construction  and  Organization :  Plans  for  Johns  Hopkins  Hospital,  p.  335 
et  seg.    New  York,  1875. 


VENTILATION    AND    HEATING.  185 

The  space  between  the  floor  and  ceiling  below  should  be 
filled  with  some  fire-proof  non-conducting  material,  such  as 
cement  or  hollow  bricks,  in  order  to  isolate  each  floor  or  ward 
as  much  as  possible  from  others,  both  to  prevent  transmission 
of  noise  and  extension  of  fire. 

All  corners  and  angles  on  the  inside  of  the  building  should 
be  rounded  to  facilitate  the  removal  of  dust. 

In  cleaning  up,  care  should  be  taken  not  to  stir  up  the 
layers  of  dust  too  much  by  active  sweeping  or  dusting.  The 
floors,  furniture,  door-  and  window-  casings  should  be  wiped  off 
with  damp  cloths.  Soiled  bedding,  clothing,  dressings,  and 
bandages  must  be  promptly  removed  from  the  ward.  Mat- 
tresses and  other  bed-clothing  should  not  be  shaken  in  the  ward.1 

Water-closets  or  (where  the  dry  method  of  removal  of  ex- 
creta is  in  use)  earth-  or  pail-  closets  should  be  placed  where 
they  can  be  easily  reached  by  the  patients,  but  the  apartment  in 
which  they  are  placed  must  not  open  directly  into  the  ward. 
The  entrance  to  this  apartment  should  be  from  the  corridor 
or,  better  still,  from  the  open  air.  The  ventilation  of  water- 
closets  should  be  independent  of  and  entirely  distinct  from 
that  of  the  ward  or  other  part  of  the  hospital  building. 

It  is,  of  course,  unnecessary  to  more  than  call  attention  to 
the  vital  importance  of  the  prompt  removal  of  all  excreta,  both 
solid  and  liquid,  from  the  ward  or  hospital  building.  To  at- 
tempt disinfection  of  excreta  and  allow  them  to  remain  in  the 
ward  after  being  voided  is  a  pernicious  practice,  which  should 
under  no  circumstances  be  permitted.  All  utensils  for  the  re- 
ception of  excreta,  bed-pans,  etc.,  should  be  immediately  emptied 
and  thoroughly  cleansed. 

Urinals  are  not  advisable ;  the  simple  hopper-closet  with 
hinged,  hard-wood  seat,  as  described  in  Chapter  VI,  is  sufficient. 

A  bath-room  and  lavatory  should  be  attached  to  every 
ward.     It   should  be  placed  in  the  service  building,  and  be 

'A  Wernich  :  Ueber  Verdorbene  Luft  in  Krankenrseumen.  Volkmann's  Samml.  Klin. 
Vortr.,  No.  179,  p.  24. 


186  TEXT-BOOK   OF   HYGIENE. 

easily  accessible  to  the  patients.  There  should  also  be  portable 
bath-tubs  in  order  that  baths  may  be  given  in  the  wards  when 
necessary. 

Every  large  general  hospital  should  also  have  a  special 
apartment  or  building  where  baths  of  various  kinds,  such  as 
medicated,  vapor,  Turkish,  and  Russian  baths,  could  be  given. 
In  lying-in  hospitals,  special  arrangements  for  giving  vaginal 
and  uterine  douches  must  also  be  furnished. 

A  daily  water-supply  of  at  least  450  litres  per  bed  should 
be  provided.  The  water  should  be  easily  accessible  from  the 
wards  and  various  parts  of  the  service  building. 

All  water-closets,  soil-  and  waste-  pipes  must  be  properly 
trapped ;  all  joints  must  be  properly  made  and  all  sewer  con- 
nections made  on  the  most  improved  plans.  All  work  of  this 
sort  should  be  properly  tested  before  being  accepted,  and 
frequently  inspected  afterward. 

No  sewer  or  house-drain  should  be  laid  under  a  ward. 

A  disinfecting  chest  for  disinfecting  soiled  clothing,  bed- 
ding, dressings,  etc.,  should  be  placed  in  the  basement  of  the 
ward,  and  connected  with  the  latter  by  an  iron  chute,  closing 
perfectly  by  an  iron  top.  The  best  and  most  convenient  disin- 
fectant is  steam.  This  is  also  the  best  means  to  destroy  vermin 
in  clothing  and  bedding. 

It  is  questionable  whether  a  nurse's  room  should  be 
attached  to  a  hospital  ward.  The  nurse's  place,  when  on  duty, 
is  in  the  ward  itself,  not  in  a  room  separate  from  it.  Where 
there  is  a  nurse's  room,  it  should  not  be  furnished  with  sleeping 
arrangements,  for  this  is  a  strong  temptation  to  neglect  of  duty 
on  the  part  of  the  nurse.  A  nurse  not  on  duty  should  not  be 
permitted  to  remain  about  the  ward. 

A  ward-kitchen  should  be  in  the  service  building,  where 
articles  of  food  can  be  kept  hot  or  cold  when  necessary,  and 
where  special  dressings,  cataplasms,  hot  water,  etc.,  can  be  pre- 
pared. A  small  gas-stove  only  should  be  allowed  in  the  ward- 
kitchen,  as  the  regular  meals  of  the  patients  are  prepared  in  the 


ADMINISTRATION  AND  MANAGEMENT  OF  A  GENERAL  HOSPITAL.        187 

central  kitchen,  which  should  be  totally  detached  from  the 
hospital.  The  ward-kitchen  can  be  easily  utilized  as  a  nurse's 
room,  and  in  a  small  hospital  can  also  be  used  as  a  store-room 
for  the  patients'  body-  and  bed-  linen  and  clothing. 

The  dining-room  for  patients  able  to  be  out  of  bed  should 
be  in  the  service  building.  A  room  with  a  good  light  and  well 
ventilated  and  heated  should  be  selected  for  this  purpose.  In 
the  intervals  between  meals  this  room  could  be  used  as  a  day- 
room  for  such  patients  as  should  be  out  of  bed,  but  who  are  not 
able  to  be  in  the  open  air. 

A  dead-house,  containing  a  dead-room,  autopsy-room,  and 
a  room  fitted  up  for  rough  microscopic  and  possibly  photo- 
graphic work,  is  a  necessity  to  every  well-appointed  general 
hospital.  The  dead-house  should  be  entirely  separate  from  the 
ward  buildings. 

The  kitchen  should  be  separate  from  the  other  buildings, 
and  in  large  hospitals  should  also  be  the  central  station  for  the 
heating  arrangements,  if  hot  water  or  steam  are  to  be  used.  The 
laundry  may  be  connected  with  it.  The  kitchen  should  be  con- 
nected with  the  wards  by  means  of  a  covered  corridor  to  avoid 
exposure  in  carrying  the  food  to  the  wards. 

The  administration  building  should  contain  office-rooms 
for  the  superintendent  and  resident  physician,  pharmacy,  library, 
reception-rooms  for  visitors,  living-rooms  for  one  or  more  assist- 
ants, and  dwellings  for  the  superintendent  and  resident  physician. 

THE    ADMINISTRATION    AND    MANAGEMENT    OF  A  GENERAL   HOSPITAL. 

The  general  management  of  .a  hospital  should  be  under  the 
direction  of  a  superintendent,  who,  besides  being  a  medical  man, 
should  be  especially  qualified  by  study  and  experience  for  the 
work.  The  superintendent  of  a  large  hospital  should  not  be 
expected  to  perform  any  of  the  routine  professional  work  in  the 
wards,  but  he  should  be  responsible  for  the  service,  both  profes- 
sional and  lay,  in  the  hospital.  He  should  be  the  financial 
officer,  and   in  all   other  things   concerning  the   hospital  his 


188  TEXT-BOOK   OF   HYGIENE. 

judgment  should  decide.  He  should  have  sufficient  assistance 
to  permit  all  necessary  duties  to  be  promptly  performed.  For 
this  purpose  he  should  have  a  secretary,  or  clerk,  who  should 
not  be  a  medical  man;  otherwise  the  attention  of  the  latter 
might  be  withdrawn  from  his  clerical  duties  to  the  more  inter- 
esting  professional  work  in  the  hospital.  The  plan  advocated 
by  some  authorities,  to  have  two  superintendents  for  large  hos- 
pitals,— one  of  whom  shall  be  a  medical  man  and  direct  only  the 
professional  work  of  the  hospital,  while  the  other  shall  have 
charge  of  the  administrative  functions, — does  not  commend  itself 
to  the  author.  It  involves  a  division  of  responsibility  which  will, 
in  nearly  all  cases,  eventually  lead  to  differences  of  opinion 
likely  to  prove  unfavorable  to  the  best  interests  of  the  hospital. 

It  is  customary  in  this  country  to  appoint  as  resident  physi- 
cians and  surgeons  in  hospitals,  recent  graduates,  whose  functions 
are  usually  limited  to  carrying  out  the  directions  of  the  visiting 
physicians  and  surgeons,  and  sometimes  to  act  on  their  own 
responsibility  in  emergencies.  This  system  has  some  advantages 
for  the  physicians,  but  is  usually  detrimental  to  the  best  interests 
of  the  patients.  The  resident  medical  officer  in  a  large  hospital 
should  always  be  a  thoroughly  qualified,  experienced  physician, 
capable  of  deciding  promptly  when  the  occasion  arises,  and  he 
should  be  responsible  to  the  superintendent  for  the  proper  per- 
formance of  his  professional  duties.  Necessarily,  a  physician 
with  the  qualifications  indicated,  would  demand  a  very  much 
larger  salary  than  is  usually  paid  resident  physicians,  but  it 
should  be  understood  that  no  hospital  in  which  the  good  of 
the  patient  is  the  first  consideration  can  be  conducted  on  a  cheap 
basis. 

Visiting  physicians  and  surgeons  and  all  resident  medical 
officers  should  be  chosen  with  reference  to  their  general  and 
special  qualifications  for  the  duties  expected  of  them.  It  would 
seem  to  be  a  good  plan  to  make  the  selections  for  subordinate 
positions,  at  least,  by  competitive  examination. 

The  sick  in  a  hospital  should  be  properly  classified.     Male 


ADMINISTRATION  AND  MANAGEMENT  OF  A  GENERAL  HOSPITAL.       189 

and  female  patients  should,  of  course,  be  treated  in  separate 
wards.  A  primary  classification  into  medical,  surgical,  and 
obstetrical  cases  or  wards  is  also  indicated.  Infections  dis- 
eases, such  as  typhoid  fever,  erysipelas,  cholera,  yellow  fever, 
croupous  pneumonia,  etc.,  should  not  be  treated  in  the  same 
wards  with  rheumatism,  Bright's  disease,  cardiac  and  nervous 
disorders,  or  simple  digestive  derangements.  It  is  questionable, 
however,  whether  it  is  advisable  to  make  a  very  elaborate  classi- 
fication of  the  various  diseases  except  in  very  large  hospitals. 

An  accurate  record,  made  at  the  time  of  observation,  and 
not  written  from  memory  afterward,  should  be  kept  of  the  his- 
tory and  progress  of  every  case.  The  record  should  show  not 
merely  the  symptoms  and  diagnosis,  but  the  medical  and  hy- 
gienic treatment.  In  most  hospitals  where  such  records  are 
kept  the  entries  are  made  either  in  a  simple  memorandum-book 
or  in  a  more  or  less  complicated  case-record.  A  simple  form 
of  case-record  has  been  devised  by  Surgeon  Walter  Wyman, 
United  States  Marine  Hospital  Service,  which  seems  to  possess 
advantages  that  render  its  general  adoption  desirable. 

The  following  convenient  form  of  record  for  obstetric  cases 

is   used    in    the    Maryland    Maternite  under   direction  of  the 

author : — 

Table  XIX. 

Obstetric  Case-Record  of  Maryland  Maternite. 

Name 

Date  of  Admission 

Registered  No Confinement  No 

Labor  began,  Date Hour Minute 

Date  of  Delivery Hour Minute 

Previous  Confinements •. 

EXTERNAL   MEASUREMENTS   OP   PELVIS. 

Between  Anterior  S.  S.  Processes 

Between  Widest  Part  of  Iliac  Crests 

External  Conjugate  Diameter 


DURATION   OP   LABOR  AND   CHARACTER   OP   PAINS. 

1st  Stage Hours Minutes      

2d  Stage Hours Minutes      

3d  Stage Hours Minutes      


190 


TEXT-BOOK    OF    HYGIENE. 


Rupture  of  Membranes Hour  .    .    . 

Maternal  Pulse  During  Pains Between  Pains.    .    .    . 

Drugs  Used Quantity When  . 

Operations  Performed . 

Pelvis Cervix Perinseurn  . 

Date  of  Beginning  Milk  Flow. 

Pulse  and  Temperature  for  Same  Date.    ....    .  For  Previous  Day. 

Method  of  Delivery  of  Placenta 

Position  when  Delivered 

Weight Length 

Breadth Thickness  ......... 

Shape 


Minute 


Time  of  Tying  Cord Length    ..... 

Spiral Point  of  Insertion 

Knots Varicosities    .    .    . 


Urine  Before 
Labor. 

1st  Day 
After  Labor. 

8th  Day 
After  Labor. 

PULSE   AND   TEMPERATURE. 


1st  day 

2d  " 

3d  " 

4th  " 

5th  " 

6th  " 

7th  " 

8th  " 

9th  " 

10th  " 


9  A.M. 


7  P.M. 


CHILD. 

Presentation  and  Position Sex 

Fcetal  Heart  Between  Pains During  Pains    .    .    . 

Caput  Succedaneum Respiration 

Circulation Temperature 

Weight  at  Birth 3d  Day 6th  Day 

Method  of  Feeding 


Length  at  Birth 


MEASUREMENTS. 

....      Length  4th  Day 


ADMINISTRATION  AND  MANAGEMENT  OF  A  GENERAL  HOSPITAL.       191 


DIAMETERS. 


4th  Day. 


Occipito-Frontal.    .    . 
Occipito-Mental ... 
Suboccipito-Bregmatic 
Biparietal 


CIRCUMFERENCES. 


4th  Day. 


Occipito-Frontal    .    .    . 
Suboccipito-Bregmatic 

Shoulders 

Hips 


Discharged  .    . 
Name  of  Nurse 


In  hospitals  where  cases  of  surgical  diseases  and  injuries  are 
received,  a  special  apartment  should  be  fitted  up  as  an  operating 
room.  Operations  should  not  be  performed  in  a  ward  in  the 
presence  of  other  patients. 

[The  following  works  are  recommended  for  additional  study 
upon  this  subject: — 

Hospital  Construction  and  Organization  ;  New  York,  1875  (espe- 
cially the  essays  of  Drs.  Billings,  Folsom,  and  Stephen  Smith). — Kran- 
kenanstalten,by  L.  Degen,  in  V.  Pettenkofer  und  Ziemssen's  Handbucli 
der  Hygiene. — Spital,  by  C.  Bdhm,  in  Realencyclopadie  d.  ges.  Heil- 
kunde,  Bd.  XII. — General  Principles  of  Hospital  Construction,  by  F.  H. 
Brown,  in  Buck's  Hygiene  and  Public  Health,  vol.  i.] 


CHAPTER  VIII. 

Schools. 

The  hygiene  of  schools  comprises  the  consideration  of  the 
sanitary  principles  underlying  the  construction  of  school-houses 
and  school-furniture;  the  proper  amount  of  time  to  be  devoted 
to  study  at  different  ages  ;  the  special  diseases  of  school-children, 
their  causes,  and  means  for  their  prevention. 

CONSTRUCTION    OF    SCHOOL-HOUSES. 

In  the  construction  of  school-houses  the  same  hygienic 
principles  are  applicable  as  in  dwelling-house  construction.  The 
selection  of  a  site  for  the  school-building  should  command  the 
same  careful  consideration  that  is  necessary  in  determining  upon 
a  site  for  a  dwelling.  Proximity  to  marshes  and  other  unsan- 
itary surroundings  should  be  avoided.  If  the  soil  is  damp  it 
should  be  properly  drained,  and  all  sources  of  insalubrity  in  the 
neighborhood  avoided  or,  if  possible,  removed. 

School-houses  should  not  be  over  three  stories  high ;  cor- 
ridors and  stairways  should  be  wide,  straight,  and  well  lighted. 
All  stairs  should  be  securely  built,  and  be  guarded  with  ample, 
strong  railing.  All  doors  should  open  outward  to  permit  ready 
egress  and  reduce  the  danger  of  accident  in  panics  from  any 
cause. 

In  addition  to  the  study-  or  recitation-  rooms,  provision 
should  be  made  for  play  and  calisthenic-exercise  rooms.  Well- 
lighted  and  ventilated  side-rooms  should  be  provided  for  the 
reception  of  outside  clothing,  umbrellas,  overshoes,  etc.  These 
articles  should  not  be  kept  in  the  recitation-  or  study-  rooms. 

Floors  should  be  made  of  accurately-joined  flooring,  and 
rendered  impervious  by  oil  or  parafhne  coating. 

13  (193) 


194  TEXT-BOOK   OF   HYGIENE. 

Appropriate  measures  must  be  employed  to  prevent  the 
permeation  of  the  building  by  ground-air. 

The  inside  walls  of  school-rooms  may  be  tinted  a  neutral 
gray,  or  light  blue  or  green.  Ceilings  should  be  white.  Walls 
and  ceilings  should  not  be  painted,  but  lime-coated  to  permit 
free  transpiration  of  air. 

Schools  should  be  so  constructed  as  to  permit  of  ready 
heating  and  ventilation,  cleaning,  and  keeping  clean.  In  large 
schools  the  method  of  heating  will  usually  be  by  furnace-heated 
air,  although  a  better  method  would  probably  be  by  steam- 
or  hot-water  pipes. 

The  ventilation  of  school-rooms  must  be  carried  out  on  the 
principles  indicated  in  Chapter  I.  With  careful  and  intelligent 
teachers,  natural  ventilation  will  give  better  satisfaction  than  a 
complicated  artificial  system.  Where  windows  and  doors  must 
be  largely  depended  upon  for  ventilation,  the  Bury  window  ven- 
tilator, illustrated  on  a  previous  page,  will  give  satisfactory  results 
unless  the  school-room  is  overcrowded.  Opening  the  doors  and 
windows  when  the  pupils  are  out  of  doors — flushing  the  rooms 
with  fresh  air — is  an  excellent  aid,  and  is  even  useful  in  cases 
where  the  most  elaborate  artificial  system  of  ventilation  is  in  use. 

A  model  study-room,  according  to  modern  views,  should 
be  about  9  to  10  metres  long,  not  over  7  metres  wide,  and  4  to 
4|-  metres  high.  Such  a  room  could  be  easily  lighted  by  win- 
dows on  one  side  only,  and  readily  heated  and  ventilated.  It 
would  also  enable  the  teacher  to  exercise  a  close  supervision 
over  his  pupils.  In  a  room  of  this  size  forty  pupils  would  be  a 
proper  number,  although  fifty  could  be  accommodated.  The 
initial  air-space  for  each  pupil  would  be  5.60  cubic  metres  if 
there  were  fifty  pupils  in  the  room,  and  7  cubic  metres  if 
there  were  only  forty.  This  would  be  slightly  reduced  by  the 
allowance  for  the  teacher. 

It  is  believed  that  study-rooms  should  face  toward  the 
north.  The  light  entering  from  the  north  side  of  a  building 
would  be  equable  during  a  whole  day.    While  a  larger  window 


CONSTRUCTION    OF    SCHOOL-HOUSES.  195 

surface  would  be  necessary  than  with  an  easterly  or  southerly 
exposure,  it  is  held  that  the  light,  being  devoid  of  all  glare, 
would  be  more  effective.  Where  the  light  is  admitted  on  the 
east,  south,  or  west  sides  of  the  building,  the  direct  entrance  of 
the  sun's  rays  must  be  prevented  by  curtains,  by  means  of  which 
the  amount  and  proper  distribution  of  the  light  is  regulated 
with  difficulty. 

The  windows  of  the  school-room  should  reach  from  about 
the  height  of  the  pupil's  shoulder  (when  seated)  to  nearly  or 
quite  to  the  ceiling.  Arches  or  overhanging  cornices  over  the 
windows  should  be  avoided,  as  they  cut  ofT  much  light.  For 
the  same  reason  the  near  proximity  of  other  high  buildings 
and  of  trees  should  be  avoided  in  selecting  a  site  for  a  school- 
house.  The  window  area  should  be  not  less  than  one-fifth  of 
the  floor  area,  otherwise  the  light  will  be  deficient. 

The  light  should  be  admitted  only  from  the  left  side  of  the 
pupil.  When  admitted  from  the  right  side  the  shadow  cast  by 
the  pen  in  writing  interferes  with  good  vision ;  if  admitted 
directly  in  front  of  the  pupil,  the  glare  of  the  light  will  injuri- 
ously affect  the  eyes ;  while,  if  it  enter  from  behind,  the  book 
or  paper  of  the  pupil  will  be  so  much  in  shadow  as  to  compel 
him  to  lean  so  far  to  the  front  in  bringing  his  eyes  nearer  to 
book  or  paper  that  nearsightedness  is  very  likely  to  be  devel- 
oped. Furthermore,  if  the  light  is  admitted  into  the  room  at 
the  backs  of  the  pupils,  the  eyes  of  the  teacher  are  liable  to 
suffer  from  the  constant  glare. 

In  a  school-room  of  the  dimensions  above  stated,  a  row  of 
windows  on  one  side,  forming  an  area  of  glass  one-fifth  of  the 
floor-space,  will  thoroughly  and  satisfactorily  illuminate  the 
room,  with  the  least  unfavorable  influence  upon  the  organs  of 
vision.  It  is  advisable,  therefore,  to  always  insist  on  this 
arrangement  of  lighting  of  school-rooms.  Where  artificial 
light  is  used  in  a  school-room,  it  should  be  in  the  proportion 
of  one  burner  to  every  four  pupils.  All  burners  should  be 
provided  with  chimneys  and  vertical  reflectors. 


196  TEXT-BOOK   OF    HYGIENE. 

Water-closets  and  privies  should  not  be  placed  in  cellars  or 
basements.  This  would  seem  to  be  self-evident,  and  yet  in 
many  city  school-houses  these  places  of  retirement  are  in  this 
unsuitable  location.  When  it  is  considered  that  large  schools 
are  frequently  warmed  by  hot  air  taken  from  the  cellar,  it 
furnishes  an  additional  reason  to  avoid  this  location  for  water- 
closets.  On  the  contrary,  the  custom,  in  some  country  schools, 
of  placing  the  privy  at  a  considerable  distance  from  the  school- 
room and  in  an  exposed  situation,  is  almost  equally  reprehen- 
sible, as  the  pupils,  especially  girls,  are  prone  to  neglect  obeying 
the  calls  of  nature,  from  which  neglect  many  disorders  arise. 

In  a  recently-introduced  system  of  ventilation  and  excre- 
ment removal  for  schools,  the  closets  are  in  the  basement,  and 
the  excrement,  as  voided,  is  rapidly  dried  by  a  current  of  air, 
and  the  odor  in  this  way  quickly  destroyed.  Unfortunately,  in 
thus  drying  the  excrementitious  matter,  micro-organisms  may 
be  taken  up  in  the  air-currents  and  carried  into  the  school-rooms. 

SCHOOL   FURNITURE. 

Desks  should  be  slightly  sloping,  the  edge  nearest  the  pupil 
being  about  1  inch  (2.5  centimetres)  higher  than  his  elbows. 
The  front  edge  of  the  seat  should  project  a  little  beyond  the 
near  edge  of  the  desk,  so  that  a  plumb-line  dropped  from  the 
latter  should  strike  the  seat  near  its  front  edge.  If  the  seat  is 
not  thus  brought  slightly  under  the  desk,  the  pupil  is  compelled 
to  lean  forward  in  writing,  which  position  prevents  proper  ex- 
pansion of  the  chest  and  increases  the  blood-pressure  in  the 
eyes, — a  condition  promotive  of  near-sightedness. 

Seats  should  be  only  high  enough  so  that  the  feet  rest  flat 
upon  the  floor.  If  they  are  higher,  a  foot-board  must  be  pro- 
vided. Children  should  not  be  condemned  to  the  cruelty  of 
having  their  feet  dangling  "  between  heaven  and  earth  "  while 
they  keep  their  seats.  Seats  and  desks  should  be  graded 
according  to  the  sizes  of  the  pupils — not  their  ages  or  standing 
in  the  class. 


SCHOOL    FURNITURE. 


197 


An  ideal  seat  and  desk  would  be  one  made  to  measure  for 
each  pupil,  but  this  is  manifestly  impracticable,  inasmuch  as 
with  the  constant  growth  of  the  child  the  seats  would  be  rapidly 


outgrown. 


The  desk  shown  in  Fig.  19  *  is  adjustable  to  children  of 
different  sizes,  and  seems  to  solve  the  problem  which  has  so  long- 
puzzled  the  school  sanitarian.  The  desks  are  made  for  a  single 
pupil   and    the   seat    and   desk   are    independently  adjustable. 


Fig.  19.— Adjustable  School-Desk.    (Front  View) 

The  frame  is  of  iron  and  the  seat,  back,  and  desk  of  hard-wood 
lumber. 

Blackboards  should  not  be  placed  at  a  greater  distance  than 
10  metres  from  the  farthest  pupil.  The  ground  of  the  board 
should  be  a  dead  black,  without  lustre.  In  writing  exercises 
upon  the  board,  care  should  be  taken  that  the  letters  and  figures 
are  made  sufficiently  large,  and  with  rather  heavy  strokes  of  the 
crayon,  in  order  that  they  may  be  easily  seen  from  the  most  distant 
part  of  the  room.  It  has  recently  been  demonstrated  that  a  black 
letter  on  a  white  ground  can  be  seen  at  a  greater  distance  than 

1  Made  by  the  Rushville  School  Furniture  Company,  Rushville,  Ind.,  IT.  S.  A. 


198  TEXT-BOOK   OF   HYGIENE. 

a  white  letter  on  a  black  ground.  Hence,  it  might  prove 
advantageous  to  the  eye-sight  of  school-children  to  substitute 
for  the  present  blackboard  and  chalk,  a  white  board  and  black 
crayon.  In  some  European  lecture-rooms  this  plan  has  been 
adopted  with  satisfaction. 

AMOUNT    OF   TIME   TO   BE   DEVOTED   TO    STUDY. 

Young  children  should  not  be  kept  at  the  same  study  or 
in  the  same  position  for  long  at  a  time.  The  exercises  should 
be  frequently  varied.  It  is  especially  with  children  in  the 
primary  grades  that  care  should  be  taken  not  to  overburden 
their  minds  with  too  many  hours  of  study,  or  too  long  con- 
tinuance at  the  same  exercise. 

Children  should  not  be  placed  in  school  much,  if  at  all, 
before  the  completion  of  their  7th  year.  From  7  to  9  years 
they  should  be  kept  at  their  studies  not  longer  than  three  hours 
daily;  from  9  to  12  years  four  hours  may  be  allotted  them;  and 
from  12  to  16  years  they  may  be  kept  at  mental  work  five  to  six 
hours  daily.  This  does  not  mean  that  pupils  are  to  be  kept 
continuously  at  their  studies  during  these  hours,  but  that  they 
should  be  neither  compelled  nor  permitted  to  study  longer  than 
these  periods  each  day.  It  is  believed  that  these  figures  repre- 
sent the  capacity  for  endurance  in  the  majority  of  children,  and 
they  should  be  adopted  in  all  schools  where  the  largest  return 
in  mental  acquirements  is  desired  at  the  least  expenditure  of 
health.  Excess  of  time  expended  in  study  is  almost  certainly 
followed  by  physical  deterioration.  "A  little  less  brain:  a  little 
more  muscle,"  for  our  children,  is  a  legitimate  demand  that  we 
may  make  of  legislators  and  school-boards. 

Gymnastic  exercises  should  form  part  of  the  daily  routine 
in  all  schools.  These  exercises  should  take  place,  when  practi- 
cable, in  the  open  air.  Playing,  romping,  laughing,  and  sing- 
ing should  be  encouraged,  rather  than  the  natural  tendency 
to  boisterous  play  restrained.  It  is  especially  desirable  that 
female  children  should  be  encouraged  to  take  part  in  these 


DISEASES    OF    SCHOOL-CHILDREN.  199 

diversions.  The  desire,  on  the  part  of  many  parents,  to  see 
little  girls  deport  themselves  as  young  ladies,  before  the  time 
even  when  they  write  their  age  in  two  figures,  is  very  rep- 
rehensible, and  deserves  the  most  unqualified  condemnation. 
Moliere's  satirical  remark,  "  II  n'ya  plus  d'enfants,"  seems  to 
be  literally  true  at  the  present  day. 

DISEASES   OF    SCHOOL-CHILDREN". 

The  principal  diseases  incident  to  school-life  are  myopia, 
spinal  deformities,  nervous  and  digestive  disorders,  pulmonary 
phthisis,  and  contagious  diseases.  It  is  believed  that  by  judi- 
cious sanitary  measures  these  can  all  be  very  much  diminished 
and  some  entirely  prevented. 

It  has  been  shown  by  the  examination  of  the  eyes  of  school- 
children that  near-sightedness  increases  progressively  from  the 
lowest  to  the  highest  classes.  Children  who  enter  school  with 
an  hereditary  tendency  to  myopia,  or  who  are,  perhaps,  already 
near-sighted  to  a  slight  degree,  soon  become  more  intensely 
myopic ;  while  others,  who  may  be  even  hypermetropic  on  enter- 
ing school,  will  be  found  to  have  become  near-sighted  during 
school-life.  In  examinations  of  over  30,000  pupils  of  grammar 
and  high  schools  in  Germany,  Austria,  Russia,  and  Switzerland, 
it  has  been  found  that  the  average  proportion  of  near-sightedness 
is  a  fraction  over  40  per  cent.,  varying,  in  the  different  classes, 
from  22  per  cent,  for  the  lowest  to  58  per  cent,  for  the  highest 
classes.  These  figures  represent  the  averages  of  all  the  ex- 
aminations made.  In  some  particular  schools,  for  example  in 
the  gymnasium  (high  school)  of  Erlangen,  the  percentage  in  the 
higher  classes  was  88  per  cent.,  in  the  gymnasium  of  Coburg 
86  per  cent.,  and  in  the  gymnasium  of  Heidelberg  the  propor- 
tion of  myopic  students  in  the  highest  class  is  said  to  have 
reached  100  per  cent,  in  1877.  In  the  primary  schools  the  per- 
centage was  found  to  be  much  lower.  Recent  investigations  in 
the  schools  of  Stockholm,  by  Widmark,  show  that  among 
school-children  examined  under  7  years   of  age  there  Avas  no 


200 


TEXT-BOOK   OF   HYGIENE. 


myopia.  In  the  higher  classes  the  myopia  increases  not  only 
in  degree,  but  in  frequency.  The  diagrams,  Figs.  20  and  21, 
show  graphically  the  increase  in  degree  and  frequency  of 
myopia  in  the  several  school-classes.  These  observations  show 
that  the  number  of  myopic  individuals  bears  a  constant  relation 
to  the  intensity  of  use  of  the  visual  organs.  The  results  of  the 
observation  of  different  observers   in    different  countries    also 


Fig.  20.— Myopia  According  to  School-Classes— Boys. 

uniformly  point  to  the  conclusion  that  not  only  does  the  number 
of  near-sighted  pupils  increase  as  the  higher  classes  are  reached, 
but  the  degree  of  myopia  increases  likewise.  Thus,  a  pupil 
who  may  have  only  a  moderate  degree  of  myopia  on  entering 
the  school  will  have  myopia  in  a  higher  degree  as  he  advances 
in  his  classes.  Erismann  found,  on  re-examining  the  same 
pupils  annually,  that  in  six  years  13.14  per  cent,  of  those  ex- 
amined had  developed  myopia  from  emmetropia,  while  in  24.57 


DISEASES    OF    SCHOOL-CHILDREN. 


201 


per   cent,  of    near-sighted   pupils  the  degree   of  myopia  had 
increased.1 

The  principal  causes  of  the  prevalence  of  near-sightedness 
in  schools  are  badly-arranged  or  insufficient  light,  bad  air,  over- 
heating of  the  school-rooms,  improper  construction  of  desks 
compelling  children  to  lean  forward  while  reading  or  writing, 
and  badly-printed  text-books.  The  use  of  small  type,  poor 
paper,  and  bad  press-work  in  text-books  is  very  reprehensible. 
The  type  technically  known  as  Long  Primer  is  the  smallest  that 


Fig.  21.— Myopia  According  to  School-Classes— Girls. 

should  be  used  in  text-books.  That  badly-arranged  light  and 
improper  seats  are  causes  of  myopia  has  been  shown  by  Flor- 
schutz  in  his  examinations  of  the  pupils  in  the  public  schools 
of  Coburg.  He  found  that  in  the  newer  schools,  in  which  the 
light  and  seats  are  better  arranged,  the  percentage  of  near-sight 
decreased.  The  average  percentage  of  those  examined  in  1874 
was   21,  while  in   1877   it  had  been  reduced  to  15,2  showing 

1  Erismann,  Die  Hygiene  der  Schule,  in  von  Pettenkoffer  und  Ziemssen's  Handbuch  der 
Hygiene,  II  Th.,  2  Abth.,  p.  30. 

8  Quoted  by  Cobn  in  Realencyclopaedie  d.  ges.  Heilk.,  Bd.  XII,  p.  263. 


202  TEXT-BOOK   OF   HYGIENE. 

the  great  improvement  due  to  the  application  of  correct  sanitary 
principles  in  the  construction  of  school-houses. 

Defective  hearing  has  recently  been  shown  to  be  especially 
frequent  among  school-children.  A  Berlin  aurist  found  1392 
children  out  of  5902  (23.6  per  cent.)  suffering  from  ear  disease 
of  some  kind.  Dr.  Samuel  Sexton,  of  New  York,  and  the  late 
Dr.  Chas.  F.  Percivall,  director  of  music  in  the  public  schools 
of  Baltimore,  have  arrived  at  similar  results  after  examination 
of  a  large  number  of  school-children. 

Spinal  curvature  is  present  in  a  large  proportion  of  the 
children  attending  schools.  Statistics  are  not  very  full  upon 
this  subject,  but  one  author,  Guillaume,  states  that  he  found 
lateral  curvature  of  the  spine  in  218  out  of  731  school-children, 
— a  proportion  of  29.5  per  cent.  This,  of  course,  includes  the 
slighter  degrees  of  curvature,  which  cannot  properly  be  termed 
a  disease.  Among  30,000  Danish  school-children  13  per  cent, 
had  some  variety  or  degree  of  spinal  deformity.  M.  Eulen- 
burg1  found  that  among  1000  persons  with  lateral  curvature  of 
the  spine,  the  disease  began  in  887  between  the  ages  of  6  and 
14 ;  that  is  to  say,  during  the  years  of  school-life.  Girls  are 
affected  more  than  ten  times  as  often  as  boys,  the  proportion 
being  93.43  per  cent,  in  the  former  and  only  6.57  per  cent,  in 
the  latter. 

The  especial  causes  of  spinal  curvature  occurring  during 
school-life  are  improperly-constructed  seats  and  desks  and  an 
improper  position  of  the  body.  Many  pupils  habitually  assume 
a  "  twisted  "  position,  which  is  very  liable  to  produce  spinal  dis- 
tortion in  children  of  weak  muscular  development.  The  manner 
in  which  a  desk  that  is  too  high  for  the  pupil  may  produce 
spinal  distortion  is  very  well  shown  in  Fig.  22.  An  improper 
position  is  more  likely  to  be  unconsciously  assumed  by  girls  than 
by  boys.  The  clothing  is  responsible  for  this,  for  when  the  girl 
files  into  her  place  behind  the  desk,  her  clothing,  hanging 
loosely  about  her,  is  swept  back  and  forms  a  pad,  upon  which 

1  Realencyclopaedie  d.  ges.  Heilk.,  Bd.  XI,  p.  564. 


DISEASES   OF    SCHOOL-CHILDREN. 


203 


she  sits  with  one  buttock.  The  greater  elevation  of  her  seat 
on  that  side  throws  the  spinal  column  out  of  the  vertical  line, 
which  is  compensated  by  a  partial  twisting  of  the  trunk.  The 
attention  of  teachers  should  be  directed  to  this  faulty  habit, 
which  can  be  easily  corrected,  and  its  consequences  averted  by 
timely  interference. 

Nervous  disorders  are  comparatively  frequent  among  school- 
children. Headaches  are  often  due  to  insufficient  ventilation, 
improper  food,  bad  digestion,  and  excessive  mental  strain. 
Defective  light  may  also  be  the  cause  of  headaches  by  causing 


Fig.  22.— Showing  Influence  of  a  High  Desk  in  Causing  Spinal  Cuevatuee. 


ocular  fatigue.  Hysterical  and  imitative  affections  are  not 
infrequent,  and  sometimes  pass  through  entire  schools,  including 
even  the  teachers.  Girls  are,  of.  course,  more  subject  to  this 
class  of  disorders  than  boys,  but  the  latter  are  not  entirely 
exempt. 

Derangements  of  the  digestive  organs  are  exceedingly 
frequent  among  school-children.  They  can  generally  be  traced 
to  the  use  of  improper  food.  The  eating  of  cold  lunches  should 
be  discouraged  as  much  as  possible. 

Nuts,  candies,  pies,  fruit-cakes,  and,  above  all,  pickles  are 


204  TEXT-BOOK   OF   HYGIENE. 

most  fruitful  sources  of  digestive  derangements  of  children. 
The  absence  of  proper  accommodations  to  enable  children — 
especially  girls — to  answer  the  demands  of  nature  are  frequent 
sources  of  digestive  and  nervous  disorders. 

The  seeds  of  pulmonary  consumption  are  frequently  im- 
planted during  school-life.  A  neglected  cough  ;  bad  ventilation, 
under  which  term  may  be  comprised  overheating  and  cold 
draughts,  as  well  as  polluted  air;  improper  position  of  the 
body,  excessive  mental  work,  or  underfeeding,  may,  any  of 
them,  be  the  starting-point  of  this  fatal  disease. 

Especial  care  should  be  taken  to  prevent  the  introduction 
or  dissemination  of  contagious  diseases  through  schools.  The 
importance  of  this  duty  should  be  at  all  times  impressed  upon 
school-boards  and  teachers.  In  the  first  place,  no  child  should 
be  admitted  within  the  door  of  the  school-room  unless  it  first 
presents  undoubted  evidence  of  protection  against  small-pox, 
either  by  having  passed  through  a  previous  attack  or  by  a 
proper  vaccination.  In  case  of  an  actual  or  threatened  epidemic 
of  small-pox  the  entire  school,  including  teachers,  should  be 
vaccinated. 

Diphtheria  has  been  shown  to  be  frequently  spread  through 
the  agency  of  schools.1  This  fatal  disease  demands  especial 
precautions  on  the  part  of  teachers  and  others  involved  in  the 
management  of  schools,  to  prevent  its  introduction  to  these 
institutions. 

Children  should  not  be  admitted  to  school  coming  from  a 
house  where  there  is  at  the  time,  or  has  recently  been,  a  case  of 
contagious  disease,  such  as  small-pox,  diphtheria,  scarlet  fever, 
or  measles.  At  least  four  weeks  should  be  allowed  to  elapse 
after  the  termination  of  such  disease  before  a  child  from  the 
infected  house  is  re-admitted  to  the  school.  It  goes  without 
saying  that  no  child  having  itself  been  sick  with  a  contagious 
disease  should  be  admitted  to  school  until  entirely  restored  to 

1  The  Relations  of  Schools  to  Diphtheria  and  to  Similar  Diseases,  H.  B.  Baker,  Public 
Health,  vol.  vi,  p.  107. 


DISEASES    OF    SCHOOL-CHILDREN.  205 

health.  The  aforesaid  limit  of  four  weeks  is  the  briefest  period 
allowable  before  the  quarantine  of  the  infected  house  (so  far  as 
the  schools  are  concerned)  can  be  relaxed. 

When  a  case  of  contagious  disease  has  accidentally  obtained 
entrance  to  the  school,  the  pupils  should  be  dismissed  for  the 
day,  and  the  room  thoroughly  disinfected  by  means  of  sulphur, 
chlorine,  or,  what  is  better,  scrubbing  and  spraying  with  solution 
of  mercuric  chloride. 

Teachers  are  not  infrequently  guilty  of  the  grave  impru- 
dence of  sending  pupils  from  the  school  to  the  house  of  an  absent, 
child  to  inquire  the  reason  of  the  latter's  non-appearance  at 
school.  It  frequently  happens  that  the  absent  child  is  sick,  and 
the  messenger  is  invited  to  the  sick-room  to  see  his  or  her  class- 
mate. There  can  be  no  room  for  doubt  that  scarlet  fever, 
diphtheria,  and  measles  have  often  been  introduced  into  schools 
in  consequence  of  such  thoughtlessness  on  the  part  of  teachers. 

In  order  to  promote  the  proper  hygienic  management  of 
schools,  all  teachers  should  be  required  to  submit  to  an  exami- 
nation in  the  principles  and  practice  of  hygiene,  at  least  so  far 
as  school  hygiene  especially  is  concerned.  This  is  a  demand 
that  school-boards  could  reasonably  insist  upon,  and  there  can 
be  no  question  that  the  improvement  in  the  health  of  the  pupils 
would  amply  justify  the  innovation. 

[Students  may  consult  with  advantage  the  following  special 
articles : — 

D.  F.  Lincoln,  School  Hygiene,  in  Buck's  Hygiene  and  Public 
Health,  vol.  ii,  and  Lomb  Prize  Essay  on  School  Hygiene,  Concord, 
N.  H.,  1887. — F.  Erismann,  Die  Hygiene  der  Schule,  in  Von  Pettenkofer 
und  Ziemssen's  Handb.  d.  Hygiene,  II,  Th.  2  Abth. — Reuss,  Schulbank- 
frage,  in  Realencyclopeedie  d.  ges.  Heilk.,  Bd.  XII. — H.  Cohn,  Schul- 
kinderaugen,  ibid. — C.  J.  Lundy,  School  Hygiene,  Public  Health,  vol. 
ix. — Rohe,  The  Necessity  of  the  Sanitary  Supervision  of  Schools,  Journ. 
Am.  Med.  Ass'n,  Dec.  28,  1889.] 


CHAPTER  IX. 

Industrial  Hygiene. 

One  of  the  most  interesting  chapters  in  the  study  of  hygiene 
is  that  which  treats  of  the  relations  of  occupations  to  health  and 
life.  While  it  is  unquestionable  that  certain  occupations  are 
intrinsically  dangerous  to  health,  there  can  be  no  doubt  that  in 
many  instances  incidental  conditions  not  necessarily  connected 
with  the  occupation  are  factors  in  the  production  of  disease. 
Such  factors  are  bad  ventilation  and  other  insanitary  surround- 
ings, as  well  as  in  many  cases  want  of  sufficient  or  proper 
food. 

Occupations  induce  disease  by  compelling  the  workmen  to 
inhale  irritating,  poisonous,  or  offensive  gases,  vapors,  or  dust ; 
or  by  causing  the  absorption  through  the  skin  or  mucous  mem- 
branes of  irritating  or  poisonous  substances.  Changes  of  tem- 
perature, as  exposure  to  great  heat  or  cold,  produce  diseases 
which  are,  in  some  instances,  characteristic.  In  another  class 
of  cases  the  excessive  use  of  certain  organs,  as  the  nervous 
system,  the  eyes,  the  Vocal  organs,  or  various  groups  of  muscles, 
produce  characteristic  morbid  effects.  Again,  a  constrained 
attitude  while  at  work,  a  sedentary  life,  or  occupations  involving 
exposure  to  mechanical  violence  are  recognized  sources'  of  dis- 
ease and  death. 

The  following  table  gives  the  mortality  and  average  age  at 
death  of  all  decedents  over  20  years  of  age  whose  occupation 
was  specified,  in  the  State  of  Massachusetts,  for  thirty-one 
years  and  eight  months.  The  total  number  of  decedents  was 
144,954;  the  average  age  at  death,  50.90  years.  Subdivided 
into  classes  and  individual  occupations,  the  results  are  as 
follow : — 

(207) 


208 


TEXT-BOOK   OF    HYGIENE. 


Table  XX. 

Occupations  of  Persons  whose  Occupations  were,  specified,  and  whose  Deaths  were 
registered  in  Massachusetts  during  a  period  of  thirty-one  years  and  eight 
months,  ending  with  December  31,  1S74-1 


Occupations. 


Class  I.  Cultivators  of 
the  Earth:  Farmers, 
Gardeners,  etc.  .    .    . 

Class  II.  Active  Me- 
chanics Abroad .  .  . 
Brick -makers  .... 
Carpenters  and  Joiners 
Caulkers  and  Gravers 

Masons 

Millwrights 

Riggers 

Ship-carpenters     .    .    . 

Slaters  

Stone-cutters 

Tanners 

Class  III.  Active  Me- 
chanics in  Shops  .    ■ 

Bakers 

Blacksmiths 

Brewers 

Cabinet-makers     .    .    . 

Calico-printers  .... 

Card-makers 

Carriage  -  makers  and 
Trimmers 

Chair-makers     .... 

Clothiers     

Confectioners    .... 

Cooks  

Coopers 

Coppersmiths    .... 

Curriers 

Cutlers 

Distillers 

Dyers 

Founders 

Furnace-men     .    .    .    . 

Glass-blowers    .... 

Gunsmiths      

Hatters 

Leather-dressers  .   .   . 

Machinists      

Millers 

Musical-Inst.  mkrs.     . 


Number 

of 
Persons. 


31,832 


10,893 
106 

6,150 
180 

1,662 

118 

161 

873 

81 

1,025 
537 


16,576 

471 

2,402 

28 

781 

9 

39 

276 

138 

84 

85 

112 

927 

101 

366 

131 

27 

143 

361 

133 

132 

250 

356 

179 

2,097 

278 

33 


Average 
Age  at 
Death. 


65.29 


5619 
46.85 
53.33 
58.59 
50.33 
59.14 
52.25 
58  53 
40.99 
40.90 
50.36 


47.57 

47.04 
53.26 
47.11 
48.84 
52.11 
48.23 

48.21 
41.77 
56.50 
44.11 
40.82 
59.22 
45.89 
41.50 
39.21 
56.85 
45.17 
42.51 
43.42 
37.88 
48.86 
54.67 
47.23 
41.67 
57.14 
46.73 


Occupations. 


Nail-makers     .    .    .    . 
Pail-  and  Tub-  makers 

Painters 

Paper-makers  .    .    . 
Piano-forte-makers 

Plumbers 

Potters  .... 
Pump-    and     Block 

makers    .    . 
Reed-makers 
Rope-makers 
Tallow-chandlers 
Tinsmiths 
Trunk-makers 
Upholsterers 
Weavers    .    . 
Wheelwrights 
Wood-turners 
Mechanics  (not  speci 

fled)  .... 


Class  IV.  Inactive 
Mechanics  in  Shops 

Barbers  .... 

Basket-makers    .    . 

Book-binders  .    .    . 

Brush -makers      .    . 

Carvers  .... 

Cigar-makers   .    .    . 

Clock  -  and  watch 
makers 

Comb-makers  .    .    . 

Engravers     .... 

Glass-cutters    .    .    . 

Harness-makers  .    . 

Jewelers 

Operatives    .... 

Printers 

Sail-makers  .... 

Shoe- cutters     .   .    . 

Shoe-makers    .    .    . 

Silver  or  Gold  smiths 

Tailors 

Tobacconists    .    . 

Whip-makers  .    . 

Wool-sorters    .    . 


Number 

of 
Persons. 


174 

5 

1,850 

288 

111 

131 

40 

89 

9 

248 

67 
375 

48 
124 
480 
507 


2,015 


17,233 

403 

70 

150 

53 

90 

154 

100 

134 

124 

76 

423 

468 

2,138 

717 

217 

352 

9,772 

92 

1,393 

43 

99 

155 


1  Thirty-third  Registration  Report  of  Massachusetts,  p.  cvi  et  seq. 


INDUSTRIAL   HYGIENE. 


209 


Table  XX  (continued). 


Occupations. 


Class  V.  Laborers  (no 
special  trades)  .    .    . 

Laborers      

Servants 

Stevedores  

Watchmen 

Workmen  in  Powder- 
mills     

Class    VI.      Factors 

Laboring  Abroad,  etc. 

Baggage-masters  .    .    . 

Brakemen       

Butchers 

Chimney-sweeps  .    .    . 

Drivers 

Drovers 

Engin'rs  and  Firemen 

Expressmen 

Ferrymen 

Lighthouse-keepers 

Peddlers 

Sextons    

Soldiers 

Stablers  

Teamsters  ...... 

Weighers  and  G-augers 
Wharfingers 

Class  VII.     Employed 

on  the  Ocean  .... 

Fishermen  ...... 

Marines       

Naval  Officers  .... 

Pilots 

Seamen 

Class  VIII.  Merch'ts, 
Financ'rs,  Ag'ts,  etc. 

Agents 

Bankers 

Bank  Officers     .... 

Boarding-House  kprs. 

Book-sellers 

Brokers . 

Clerks  and  Book-kprs. 

Druggists  and  Apoth- 
ecaries       


Number 

of 
Persons. 


28,058 
27,382 

389 
76 

193 

18 


1,282 
24 
22 

8,844 

433 

4 

58 

82 

8,267 

15,977 

376 

49 

151 

75 

73 

198 

3,435 

255 


Average 
Age  at 
Death. 


47.41 
47.49 
40.10 
52.09 
50  06 

39.67 


7,035 

36.29 

37 

34.08 

246 

26.44 

537 

50.19 

4 

34.50 

327 

88.88 

17 

49.29 

567 

38.77 

216 

41.30 

9 

53.78 

10 

60.40 

417 

45.18 

81 

59  94 

2,885 

28.37 

354 

42.54 

40.35 
60.67 
50  00 

46.44 
42.82 
41.25 
50.00 
60.38 
46  45 

48.95 
46.76 
57.61 
55.14 
47.96 
53  05 
49.58 
35.93 

42.37 


Occupations. 


Gentlemen 

Grocers      

Innkeepers 

Manufacturers     .    .    . 

Merchants 

News-dlrs.  and  Car'rs 

R.  R.  Agents  or  Con- 
ductors     .... 

Saloon-  and  Restau 
rant-  keepers 

Stove-dealers   . 

Telegraphers    . 

Traders      .    .    . 


Class    IX.      Profes 

sional  Men  . 
Architects  .  . 
Artists  .... 
Civil  Engineers 
Clergymen  .  . 
Comedians  .  . 
Dentists  .  .  . 
Editors  and  Reprtrs 
Judges  and  Justices 
Lawyers  ..... 
Musicians  .  .  ..  . 
Photographers  .  . 
Physicians  .... 
Professors  .... 
Public  Officers  .  . 
Sheriffs,     Constables. 

and  Policemen    . 

Students 

Surveyors     .... 
Teachers 


Class  X.     Females 
Domestics     . 
Dress-makers 
Milliners   .    . 
Nurses   . 
Operatives    . 
Seamstresses 
Shoe-binders 
Straw-workers 
Tailoresses   . 
Teachers    .    . 
Telegraphers   , 


Number 

of 
Persons. 


1,512 

517 

467 

1,375 

3,927 

27 

318 

299 

12 

5 

2,908 

5,175 
'      29 

186 
117 
965 

32 
114 

87 

18 
676 
266 

10 
1,166 

45 
437 

158 

288 

86 

495 

3,343 

1,037 

259 

136 

116 

703 

289 

48 

73 

233 

442 

7 


Average 
Age  at 
Death . 


68.42 
47.59 
50.04 
51.23 
54.17 
41.22 

39.85 

40.90 
45.25 
28.80 
48.08 

50.81 
47.07 
44.18 
42.32 
58.57 
37  31 
41.61 
46.68 
64.11 
56.45 
41.59 
36.80 
54.99 
55.93 
55.37 

53.76 
23.23 
51.44 
41.79 

39.13 
46.64 
43.36 
39.42 
61.06 
27.82 
46.50 
43.12 
34  83 
47.49 
31.27 
24.43 


The  above  table  cannot  be  absolutely  relied  upon  for  several 
reasons,  the  principal  of  which  is  that  the  table  is  incomplete. 
Many  of  the  occupations  are  merely  temporary,  and  persons  are 


14 


210  TEXT-BOOK   OF   HYGIENE. 

constantly  shifting  from  the  pursuit  of  one  calling  to  another. 
Judges  and  lawyers,  for  example,  should  be  included  under  one 
heading,  while  the  class  "  students  "  should  be  excluded  alto- 
gether. The  table  shows,  however,  very  clearly,  the  relations  of 
certain  occupations  to  longevity.  It  is  seen,  for  example,  that 
agriculturists  have  the  greatest  expectation  of  life.  Next  to 
these  come  mechanics  engaged  out-of-doors.  Professional  men 
come  next,  and  of  these  clergymen  and  members  of  the  bar  have 
the  first  and  second  places,  respectively.  The  expectation  of 
life  of  physicians  is  above  the  average,  being  nearly  55  years. 
Mechanics  engaged  in  active  work  in-doors  may  expect  to  live 
3.70  years  longer  than  those  whose  occupation  requires  them  to 
retain  a  more  or  less  constant  position. 

Occupations  which  are  accompanied  by  the  formation  of 
much  dust,  either  inorganic  or  organic,  are  especially  unfavor- 
able. They  usually  produce  diseases  of  the  respiratory  organs, 
which  may  eventuate  in  phthisis.  In  the  table  it  is  seen 
that  the  average  age  at  death  of  stone-cutters  was  40.90 ;  of 
cotton-factory  operatives — male  39.16,  female  27.82  ; 1  of  cigar- 
makers,  38.36 ;  and  of  cutlers,  39.21  years.  The  figures  more 
or  less  closely  approximate  the  conditions  which  have  been 
shown  to  exist  in  England  and  on  the  Continent  of  Europe.  In 
Sheffield,  the  workmen  who  grind  and  polish  the  cutlery,  called 
"  dry  grinders,"  are  said  to  suffer  from  a  characteristic  pulmo- 
nary affection  termed  "grinders'  asthma"  (emphysema)  in  the 
proportion  of  69  per  cent,  of  the  Avhole  number  employed.  The 
average  duration  of  life  of  the  needle-grinders  of  Derbyshire 
is  30.66  years.  Among  the  cutlery-grinders  of  Solingen,  in 
Rhenish  Prussia,  Oldendorff  found  29  per  cent,  suffering  from 
pulmonary  affections,  while  the  average  age  at  death  of  the 
"dry  grinders"  was  40.7  years. 

These  figures  must  be  accepted  with  much  reserve.  While  it  is  probable  that  the 
average  age  at  death  among  women  engaged  in  different  occupations  is  less  than  that  of  men 
engaged  in  the  same  occupations,  the  figures  in  Table  XX,  Class  X,  cannot  be  used  as  a  basis  of 
comparison.  So  many  women  are  annually  withdrawn  from  the  various  occupations  by  mar- 
riage, which  places  them  under  different  conditions,  that  the  statistics  of  the  occupations  of 
■women  in  the  table  are  untrustworthy. 


OCCUPATIONS   PREJUDICIAL   TO   HEALTH.  211 

OCCUPATIONS    PREJUDICIAL    TO    HEALTH. 

The  diseases  of  occupations  may  conveniently  be  divided 
into  the  following  classes : — 

1.  Diseases  due  to  the  inhalation  of  irritating  or  poisonous 
gases  and  vapors. 

2.  Diseases  due  to  the  inhalation  of  irritating  or  poisonous 
dust. 

3.  Diseases  due  to  the  absorption  or  local  action  of  irritating 
or  poisonous  substances. 

4.  Diseases  due  to  exposure  to  elevated  or  variable  temper- 
ature or  atmospheric  pressure. 

5.  Diseases  due  to  excessive  use  of  certain  organs. 

6.  Diseases  due  to  a  constrained  attitude  and  sedentary  life. 

7.  Diseases  from  exposure  to  mechanical  violence. 

I. DISEASES  DUE  TO  THE  INHALATION  OF  IRRITATING  OR  POISONOUS 

GASES   OR   VAPORS. 

Sulphurous-acid  gas  is  used  in  various  trades  as  a  bleach- 
ing agent.  In  the  manufacture  of  straw  hats  and  in  the  drying 
or  "  processing  "  of  hops  this  agent  is  extensively  employed, 
and  the  people  engaged* in  these  industries  frequently  suffer 
from  respiratory  and  digestive  disorders.  These  are,  however, 
rarely  serious.  If  free  access  of  air  is  allowed,  the  dangers  to 
health  in  the  above  employments  are  very  slight. 

Nitric-acid  fumes  may  be  dangerous  to  health  when  in- 
haled in  a  concentrated  form,  but  very  few  cases  are  on  record 
where  any  positively  deleterious  influence  can  be  traced  to  this 
agent. 

Hydrochloric-acid  fumes  may  prove  deleterious  to  the  work- 
men in  soda  manufactories,  where  the  fumes  are  disengaged 
during  the  so-called  "  sulphate  process."  But  the  danger  is 
probably  slight.  On  the  other  hand,  attention  has  recently  been 
called  to  a  peculiar  effect  of  hydrochloric-acid  fumes  upon  the 
workmen  in  fruit-canning  establishments.  The  men  who  seal 
or  "  cap  "  the  cans  after  being  filled  are  the  ones  affected.    The 


212  TEXT-BOOK    OF   HYGIENE. 

lesion  has  been  described  by  Dr.  W.  Stump  Forwood,  who  says 
concerning  it :  "  The  constant  inhalation  of  the  fumes  of  muri- 
atic acid,  associated  as  they  are  with  the  lead  solder,  which  the 
busy  "capper"  neglects  to  protect  himself  against,  soon  pro- 
duces inflammation  of  the  mucous  membrane  of  the  nose,  which 
finally  results  in  ulceration.  With  some  patients,  after  the 
removal  of  the  cause  and  the  application  of  proper  treatment, 
recovery  takes  place  after  two  or  three  months ;  but  with  those 
who  have  a  scrofulous  taint  in  their  constitutions  this  ulceration 
is  exceedingly  intractable,  and,  in  spite  of  all  treatment,  proceeds 
for  months  and  even  years,  until  the  septum  is  finally  perforated. 
And,  strange  to  say,  it  is  the  common  experience  of  those  who 
have  suffered  that,  as  soon  as  perforation  takes  place,  all  the 
soreness  and  consequent  annoyance  disappears  and  the  patient 
recovers,  with,  of  course,  a  permanent  opening  in  the  nasal 
septum."1  Dr.  Forwood  adds  that  anointing  the  nose,  both 
within  and  without,  several  times  a  day,  and  avoidance  of  the 
acid  fumes  as  much  as  possible,  will  prevent  the  peculiar  affection. 

Ammonia  rarely  causes  disturbances  of  health  in  work- 
men brought  into  contact  with  it.  When  present  in  the  air  in 
large  proportion  it  may  give  rise  to  serious  symptoms.  As  it  is 
often  used  to  prevent  the  poisonous  effects  of  mercury  (q.  v.),  care 
should  be  taken  that  the  proportion  of  the  vapor  in  the  air  of 
the  work-room  should  not  exceed  5  per  cent. 

Chlorine  gas  is  very  deleterious  in  its  effects  upon  the  work- 
men brought  in  contact  with  it  in  the  various  industries  in  which 
it  is  employed.  Nearly  one-half  of  the  workmen  engaged  in  the 
manufacture  of  chlorinated  lime  and  in  bleaching  become  affected. 

The  respiratory  organs  are  principally  attacked.  Pneu- 
monia is  exceptionally  frequent.  If  an  affected  individual  is 
predisposed  to  consumption  the  latter  disease  is  soon  lighted  up, 
and  quickly  proves  fatal.  The  effect  of  the  inhalation  of  con- 
centrated chlorine  is  thus  graphically  described  by  Hirt 2 :   "  The 

lPhila.  Med.  and  Surgical  Reporter,  June  30,  1883. 

4  Von  Pettenkofer  und  Ziemssen's  Handbuch  der  Hygiene,  etc.,  II  Th.,  4  Abth.,  p.  30. 


DISEASES   DUE   TO   INHALATION   OF   GASES   OR   VAPORS.       213 

workman  suffers  from  violent  cough  and  extreme  dyspnoea.  In 
spite  of  the  aid  of  the  auxiliary  respiratory  muscles,  the  entrance 
of  air  to  the  lungs  is  insufficient,  and  the  widely-opened  eyes, 
the  pale-bluish  color,  and  the  cold  perspiration  plainly  show  the 
mortal  agony  of  the  patient.  With  this  the  pulse  is  small,  the 
temperature  decreased.  Soon  after  removal  from  the  impreg- 
nated atmosphere  these  phenomena  disappear,  and  a  few  hours 
later  the  workman  is  found  enveloped  in  chlorine  and  hydro- 
chloric-acid vapors  in  his  accustomed  place  in  the  factory.  The 
attacks  seem  to  be  but  rarely  fatal." 

The  constant  inhalation  of  an  atmosphere  strongly  impreg- 
nated with  chlorine  produces  a  cachectic  appearance,  bronchial 
catarrh,  loss  of  the  sense  of  smell,  and  a  prematurely  aged  appear- 
ance. When  this  stage  of  chronic  chlorine  poisoning  has  been 
reached  complete  health  can  rarely  be  re-established,  even  if 
the  patients  be  entirely  removed  from  the  irritating  atmosphere. 

Carbon  monoxide  is  often  present  in  the  air  of  gas-works, 
iron  smelting-works,  and  coke  or  charcoal  furnaces.  The  work- 
men engaged  in  these  industries  often  suffer  with  diseases  of  the 
respiratory  organs,  digestive  disturbances,  and  general  debility. 
Acute  poisoning  from  carbon  monoxide  is  relatively  frequent,  as 
already  pointed  out.1  The  prominent  symptoms  are  at  first  vio- 
lent headache,  dizziness,  and  roaring  in  the  ears.  These  symp- 
toms are  followed  by  great  depression  of  muscular  power,  nausea, 
and  vomiting.  The  vomited  matters  sometimes  gain  entrance 
into  the  trachea,  and  may  thus  produce  strangulation.  Uncon- 
sciousness, convulsions,  and  asphyxia  rapidly  succeed.  Paral- 
yses of  the  sphincters  and  of  groups  of  other  muscles  are  often 
present.  The  pulse  is  at  first  somewhat  increased,  but  soon 
becomes  slower.  The  respiration  is  slow  and  stertorous,  and  the 
temperature  falls  from  2.5°  to  3°  C.  (3°  to  4°  F.).  Glycosuria 
often  occurs.  If  death  does  not  occur  in  the  attack,  the  patient  fre- 
quently suffers  from  great  depression,  both  physical  and  mental; 
loss  of  appetite,  constipation,  and  various  paretic  conditions. 

1  See  Chapter  I,  p.  29. 


214  TEXT-BOOK   OF   HYGIENE. 

The  slow  or  chronic  form  of  poisoning  by  carbon  monoxide 
is  characterized  by  headache,  dizziness,  slow  pulse  and  respira- 
tion, nausea,  and  sometimes  vomiting  and  purging.  Loss  of 
memory  and  diminution  of  mental  activity  are  also  said  to  be 
effects  of  the  continued  inhalation  of  air  charged  with  carbon 
monoxide. 

Carbon  dioxide  is  found  as  one  of  the  constituents  of  the 
"choke-damp"  in  mines.  There  is  reason  to  believe  that  this 
is  often  the  source  of  ill  health  and  death  in  miners,  even  where 
the  symptoms  of  acute  carbon-dioxide  poisoning  are  not  present. 
Hon.  Andrew  Roy1  says  that  "it  is  more  insidious  than  direct  in 
its  operations,  gradually  undermining  the  constitution  and  kill- 
ing the  men  by  inches."  Difficulty  of  respiration  and  weakness 
are  the  only  symptoms  calling  attention  to  the  pernicious  effects 
of  the  gas.  Where,  however,  the  proportion  of  carbon  dioxide 
is  large,  acute  poisoning  occurs.  This  is  manifested  by  the 
following  symptoms :  Loss  of  consciousness  and  of  the  power  of 
voluntary  motion.  In  some  cases  there  are  convulsions ;  in 
others  the  above  symptoms  are  preceded  by  difficult  respiration, 
headache,  depression,  drowsiness,  or  psychical  excitement.  Re- 
covery usually  soon  follows  after  removing  the  patient  into  a 
purer  atmosphere. 

Vintners,  distillers,  brewers,  and  yeast-makers  are  said  to 
suffer  from  the  effects  of  carbon  dioxide  occasionally,  but  serious 
results  from  this  cause  are  probably  very  infrequent. 

It  may  not  be  amiss  to  call  attention  here  to  another  dan- 
gerous mixture  of  gases  sometimes  found  in  mines,  and  which 
is  occasionally  the  source  of  appalling  accidents.  This  is  the 
so-called  "fire-damp"  or  light  carburetted  hydrogen  (CH4). 
When  this  gas  is  mixed  with  atmospheric  air  in  the  proportion 
of  6  to  10  volumes  per  cent.,  the  mixture  becomes  violently 
explosive  if  ignited.  The  danger  does  not  cease  with  the  explo- 
sion, however,  for  in  this  act  the  free  oxygen  present  is  consumed 

1  Third  Annual  Report  State  Mine  Inspector  of  Ohio.  Quoted  in  Buck's  Hygiene  and 
Public  Health,  vol.  ii,  p.  243. 


DISEASES    DUE   TO    INHALATION    OF   GASES   OR   VAPORS.       215 

in  the  formation  of  carbon  dioxide,  and  the  workmen  then  die 
asphyxiated,  or  from  the  effects  of  "  choke-damp."  The  dangers 
from  "  fire-damp  "  can  be  largely  averted  by  thorough  ventilation 
and  by  the  use  of  the  safety-lamp  of  Sir  Humphry  Davy,  which 
gives  warning  of  the  presence  of  the  gas  and  permits  the  work- 
men to  escape  before  the  explosion  takes  place. 

Sulphuretted  hydrogen,  when  present  in  the  air  in  large 
proportion, — as,  for  example,  in  privy-vaults,  cess-pools,  and 
sewers, — may  produce  serious  or  fatal  poisoning.  Formerly, 
when  vaults  were  cleaned  in  the  primitive  way,  these  accidents 
were  frequent;  but  at  the  present  day,  owing  to  improved 
methods  of  removing  excreta,  they  are  comparatively  rare.  The 
precautions  advised  in  a  preceding  chapter1  should  be  borne  in 
mind  when  it  is  necessary  for  workmen  to  enter  such  places. 

The  gases  resulting  from  the  putrid  decomposition  of  organic 
substances,  such  as  are  found  in  tanneries,  glue-  and  soap-  works, 
and  similar  industries,  are  popularly  believed  to  give  rise  to 
various  diseases.  There  are  no  observations  on  record,  however, 
to  show  that  such  is  the  case.  As  a  matter  of  fact,  the  workmen 
engaged  in  the  industries  mentioned,  seem  to  be  exceptionally 
healthy,  and  to  resist  to  a  considerable  degree  the  ravages  of 
phthisis  and  epidemic  diseases. 

Bisulphide  of  carbon  is  used  in  the  arts  principally  in  the 
process  of  vulcanizing  India  rubber,  and  for  extracting  oils  from 
seeds  and  fatty  bodies.  The  constant  inhalation  of  the  vapor 
of  bisulphide  of  carbon  produces  a  train  of  symptoms  to  which 
attention  was  first  attracted  by  Delpech  in  1856.  The  symp- 
toms have  been  observed  frequently  since  that  time.  The  follow- 
ing account  is  from  Hirt2: — 

"  Some  days,  or  even  weeks  or  months,  after  beginning  this 
occupation,  the  workmen  complain  of  a  dull  headache,  becoming 
more  severe  toward  evening.  This  symptom  is  soon  followed  by 
joint-pains,  formication,  and  itching  on  various  parts  of  the  body. 
A  more  or  less  troublesome  cough  is  present,  but  is  not  accom- 

1  Chapter  I,  p.  37.  *  Op.  cit.,  p.  66. 


216  TEXT-BOOK   OF   HYGIENE. 

panied  by  any  characteristic  sputa.  The  respiration  is  regular, 
the  pulse  somewhat  increased  in  frequency.  During  this  time 
certain  individuals  exhibit  a  marked  exaltation  of  their  intel- 
lectual powers;  they  talk  more  than  formerly,  and  show  an 
interest  in  matters  in  which  they  at  other  times  show  no  concern. 
There  is,  however,  very  rarely  distinct  mental  disease.  The 
sexual  desires  are  increased  in  both  sexes,  menstruation  becomes 
irregular,  and  the  urine  possesses  a  faint  odor  of  bisulphide  of 
carbon.  In  this  manner  several  weeks  or  months  pass  away. 
Very  gradually  the  psychical  exaltation  disappears,  and  a  pro- 
found depression,  melancholy,  and  discouragement  succeeds, 
coupled  with  which  is  often  loss  of  memory.  Vision  and  hear- 
ing become  less  acute,  and  the  sexual  activity  is  completely 
destroyed.  Anaesthetic  spots  appear  on  various  parts  of  the  body, 
and  numbness  of  the  fingers  prevents  the  workman  from  perform- 
ing any  fine  work." 

The  disease  never  proves  fatal,  but  the  normal  condition 
of  the  individual  is  rarely  re-established  when  the  disorder  has 
advanced  to  the  extreme  stages  mentioned. 

Iodine  and  bromine  vapors,  when  inhaled  by  workmen  en- 
gaged in  their  preparation,  produce  symptoms  of  poisoning 
which  are  sometimes  very  serious.  Acute  iodic  intoxication 
consists  in  severe  laryngeal  irritation,  headache,  conjunctivitis, 
and  nasal  catarrh.  Occasionally  there  is  temporary  loss  of  con- 
sciousness. Chronic  iodic  cachexia  is  often  found  among  the 
workmen.  In  certain  cases  atrophy  of  the  testicles  and  gradual 
disappearance  of  sexual  power  has  been  observed.  In  the  manu- 
facture of  bromine,  a  form  of  bronchial  asthma  has  been 
observed  among  those  engaged  in  the  establishment.  No 
symptoms  corresponding  to  those  of  chronic  iodism  have  been 
observed  among  the  workmen  in  bromine. 

The  inhalation  of  the  vapors  of  turpentine  produces,  in  a 
considerable  number  of  those  constantly  exposed  to  them,  dis- 
eases of  the  respiratory  organs,  beginning  with  cough  and,  at 
times,  resulting  in  consumption.     In  other  cases  derangement 


DISEASES    DUE   TO    INHALATION    OF   GASES   OR   VAPORS.       217 

of  the  digestive  organs,  strangury,  and,  in  a  few  cases,  bloody 
urine  have  been  observed.  Nervous  disturbances  are  rare  after 
the  inhalation  of  turpentine,  and  are  limited  to  headache,  roar- 
ing in  the  ears,  or  flashes  of  light  before  the  eyes. 

Petroleum  vapor,  when  inhaled  in  a  concentrated  state,  pro- 
duces symptoms  similar  to  those  of  anesthetics.  When  exposed 
for  a  long  time  to  diluted  petroleum  vapor,  workmen  sometimes 
suffer  from  chronic  pulmonary  catarrhs  or  from  nervous  de- 
rangements. Among  the  latter  are  disturbances  of  mental 
activity,  loss  of  memory,  giddiness,  and  headache.  These  symp- 
toms are,  however,  rare.  More  frequent  are  pustular  or  furuncu- 
lar  affections  of  the  skin,  which  are  due  probably  to  the  direct 
irritant  effect  of  the  vapor. 

Lead  poisoning  is  one  of  the  most  characteristic  diseases  of 
artisans.  It  attacks  workmen  engaged  in  the  roasting  and  smelt- 
ing of  lead  ores ;  in  the  manufacture  of  white  and  red  lead  and 
of  lead  acetate  and  chromate ;  in  type-making,  in  painting,  and, 
in  short,  in  all  occupations  in  which  the  workman  is  compelled 
to  inhale  the  vapor  or  dust  of  lead,  or  in  which  it  is  conveyed 
in  some  manner  to  the  digestive  organs.  It  is  believed  also  that 
it  can  be  absorbed  by  the  skin  and  produce  its  poisonous  effects 
upon  the  economy.  The  average  duration  of  life  in  the  roast- 
ing and  smelting  furnaces  is  41  years ;  of  painters,  as  shown  by 
Table  XX,  45.07  years.  Of  the  latter  75  per  cent,  are  attacked 
by  one  of  the  forms  of  lead  poisoning,  colic  being  most  frequent. 
In  the  manufacture  of  white  lead  more  than  half  of  the  work- 
men suffer  from  lead  poisoning  during  the  first  year,  lead  colic 
being  present  in  60  per  cent,  of  all  the  cases. 

In  most  sugar-of-lead  manufactories  60  per  cent,  of  all 
the  operatives  constantly  suffer  from  some  form  of  lead 
poisoning. 

Poisoning  has  also  been  observed  in  workmen  engaged  in 
the  manufacture  of  various  pigments  of  which  the  acetate  of 
lead  is  the  base  {e.g.,  lead  chromates).  Among  type-founders 
the  symptoms  of  lead  poisoning  are  not  very  rare,  and  even 


218  TEXT-BOOK   OF   HYGIENE. 

compositors  sometimes  suffer  from  lead  poisoning.  In  the  latter 
case  the  lead  must  be  absorbed  through  the  skin  in  order  to 
produce  its  effects. 

The  various  forms  in  which  lead  poisoning  affects  the  indi- 
vidual are  the  lead  cachexia,  manifested  by  loss  of  weight,  dis- 
coloration of  the  skin,  the  characteristic  blue  line  along  the 
gums,  diminution  of  the  salivary  secretion,  a  sweetish  taste,  and 
offensive  odor  of  the  breath ;  then  lead  colic,  the  features  of 
which  are  well  known ;  lead  paralysis,  the  characteristic  "  wrist- 
drop," which  requires  prompt  and  intelligent  treatment,  other- 
wise permanent  atrophy  of  the  affected  muscles  often  takes  place. 
Among  other  nervous  manifestations  of  the  poison  is  a  painful 
affection  of  the  lower  extremities,  attacking  joints  and  flexor 
muscles,  and  remittent  in  character.  At  times  anaesthesia  of  the 
skin  of  the  head  and  neck  is  present.  In  rare  cases  serious 
mental  derangement  occurs.  Other  grave  nervous  lesions,  such 
as  the  so-called  saturnine  hemiplegia  and  tabes,  are  happily 
extremely  rare  among  the  workmen  in  the  metal  at  the  present 
day. 

Mercurial  poisoning  is  frequent  among  the  artisans  who 
work  in  the  metal.  The  smelters  of  the  ore  suffer  severely  and 
in  a  large  proportion  of  the  entire  number  employed.  Their 
average  age  at  death  is  45  years.  Mirror-makers  suffer  most 
severely  of  all  the  artisans  who  come  in  contact  with  the  vapors 
of  the  metal.  It  is  beyond  question  that  the  confinement  in 
badly-ventilated  work-rooms  is  largely  responsible  for  the  poi- 
sonous effects  of  the  metal  upon  this  class.  The  special  forms 
in  which  the  poisonous  effects  are  manifested  in  mirror-makers 
are  salivation,  mercurial  tremor,  and  nervous  erethism,  but,  in 
addition,  a  very  large  proportion  suffer  from  pulmonary  con- 
sumption. It  is  stated  that  71  per  cent,  of  the  total  deaths 
among  mirror-makers  (those  who  coat  the  glass  with  the  mer- 
curial alloy)  are  from  phthisis. 

Among  women  the  symptoms  are  aggravated,  and  abortion 
frequently  occurs.     Of  the  children  of  women  suffering  from 


DISEASES   DUE   TO   INHALATION    OF   GASES   OR   VAPORS.       219 

mercurial  poisoning  born  living  at  term,  65  per  cent,  die  within 
the  first  year. 

In  the  Almaden  quicksilver  mines  in  Spain  a  considerable 
proportion  of  the  workmen  suffer  from  the  milder  symptoms  of 
mercurial  intoxication  (gingivitis,  salivation,  or  dryness  of  the 
mouth).  The  more  severe  manifestations  (tremor,  convulsions, 
contractures,  violent  muscular  pains,  paralysis,  cachexia)  are 
much  less  frequent,  and  latterly  not  so  severe  as  they  were 
formerly. 

Fire-gilders,  fulminate- makers,  and  physical  instrument- 
makers  not  infrequently  suffer  from  the  deleterious  effects  of 
inhaling  the  vapor  of  mercury.  Hatters  are  also  liable,  to  a 
considerable  extent,  to  the  poisonous  effects  of  the  metal.1 

It  has  been  found  that  upon  sprinkling  the  floor  of  the 
work-room  of  mirror-makers  with  aqua  ammonia,  so  as  to  im- 
pregnate the  atmosphere  with  ammonia,  the  bad  effects  of  mer- 
cury on  the  system  are  markedly  diminished.  Care  must  be 
taken,  however,  not  to  use  the  ammonia  to  excess,  otherwise  the 
diseases  caused  by  this  agent  may  attack  the  workmen. 

Zinc  or  copper  vapors,  or  possibly  a  combination  of  the 
two,  given  off  from  the  brass,  which  is  an  alloy  of  these  metals, 
produces  a  peculiar  train  of  symptoms  known  as  "  brass- 
founders'  ague."  The  symptoms  are  described  by  Hirt,  who 
has  suffered  from  two  attacks  of  the  affection  himself,  as  fol- 
lows 2 :  "A  few  hours  after  attending  the  process  of  brass- 
casting,  one  notices  a  peculiar,  uncomfortable  sensation  over  the 
whole  body.  More  or  less  severe  pains  in  the  back  and  gen- 
eral lassitude  cause  a  discontinuance  of  the  ordinary  occupa- 
tion. While  the  pains  appear  now  here,  now  there,  and  are 
extremely  annoying,  no  changes  in  the  pulse  or  respiration  are 
noticeable.  In  a  short  time,  however,  usually  after  the  patient 
has  taken  to  the  bed,  chilliness  comes  on,  which  soon  increases 
to  a  decided  rigor,  lasting  fifteen  minutes  or  longer.     In  the 

i  Hatting  as  Affecting  the  Health  of  Operatives,  L.  Dennis,  Report  New  Jersey  State 
Board  of  Health,  1879  ;  Connecticut  State  Board  of  Health,  1883. 
*  Op.  cit.,  p.  122. 


220  TEXT-BOOK   OF    HYGIENE. 

course  of  an  hour  or  less  the  pulse  now  reaches  a  rapidity  of 
100  to  120  beats  per  minute.  A  tormenting  cough,  combined 
with  a  feeling  of  soreness  in  the  chest,  comes  on.  In  conse- 
quence of  the  repeated  acts  of  coughing,  the  increasing  frontal 
headache  produces  exceeding  discomfort.  Soon,  however,  usu- 
ally after  a  few  hours,  the  height  of  the  attack  is  reached ;  free 
perspiration  indicates  the  stage  of  defervescence,  and  during  the 
gradual  diminution  of  the  symptoms  the  patient  falls  into  a 
deep  sleep,  lasting  several  hours.  On  awakening,  a  slight 
headache  and  lassitude  only  remain  as  reminders  of  the 
attack." 

It  is  said  that  about  15  per  cent,  of  the  workmen  in  brass- 
foundries  are  attacked  by  this  affection ;  the  attack  is  liable  to 
be  repeated  at  every  exposure. 

A  chronic  form  of  poisoning  is  said  to  occur  among  zinc- 
smelters  after  following  their  occupation  for  ten  to  twelve  years. 
It  consists  of  hyperesthesia,  formication,  and  burning  of  the 
skin  of  the  lower  extremities,  soon  followed  by  alteration  in  the 
temperature  and  tactile  sensation,  and  diminution  of  the  mus- 
cular sense.  Paresis  of  the  lower  extremities  sometimes  comes 
on.     The  disease  has  not  yet  been  sufficiently  investigated. 

Aniline  vapor  is  exceedingly  poisonous  when  inhaled  in  a 
concentrated  state.  Hirt  describes  an  acute  form  which  usually 
results  fatally:  "The  workman  falls  suddenly  to  the  ground; 
the  skin  is  cold,  pale ;  the  face  is  cyanotic,  the  breath  has  the 
odor  of  aniline,  the  respiration  is  slowed,  and  the  pulse  increased. 
The  sensation,  diminished  from  the  beginning  of  the  attack, 
gradually  entirely  disappears,  and  death  follows  in  a  state  of  deep 
coma."1  There  is  a  milder  form  which  comes  on  after  several 
days  of  exposure.  It  is  characterized  by  laryngeal  irritation, 
diminution  of  appetite,  headache,  giddiness,  great  weakness, 
and  depression.  The  pulse  is  rapid,  small,  and  irregular. 
Respiration  is  little  altered.  There  is  decrease  of  sensibility  of  the 
skin.    Convulsions  may  occur,  but  are  usually  of  short  duration. 

1  Op.  cit.,  p.  127. 


DISEASES    DUE    TO    INHALATION    OF    DUST.  221 

The  chronic  form  of  aniline  poisoning  is  characterized  by 
three  sets  of  symptoms :  those  affecting  the  central  nervous 
system,  the  digestive  tract,  and  the  skin.  Among  the  first  are 
lassitude,  headache,  roaring  in  the  ears,  and  disturbances  of 
sensation  and  motion  of  greater  or  less  degree. 

The  digestive  derangements  consist  in  eructations,  nausea, 
and  vomiting. 

The  cutaneous  lesions  are  eczematous  or  pustular  eruptions, 
and  sometimes  round,  sharply-circumscribed  ulcers  with  callous 
borders. 

There  is  no  trustworthy  evidence  that  in  the  manufacture 
of  aniline  colors  poisonous  symptoms  are  produced  in  the 
workmen. 

II. DISEASES    DUE     TO     THE    INHALATION     OF    IRRITATING    OR 

POISONOUS    DUST. 

The  inhalation  of  air  containing  particles  of  organic  or 
inorganic  matter  has  long  been  accepted  as  a  cause  of  certain 
special  diseases  of  artisans.  The  diseases  so  caused  are  usually 
limited  to  the  pulmonary  organs,  and  consist  of  acute  and 
chronic  catarrh,  emphysema  of  the  lungs,  pneumonia,  interstitial 
inflammation  of  the  lungs, — the  so-called  fibroid  phthisis  or  pul- 
monary cirrhosis. 

Coal-dust  is  inhaled  by  coal-miners,  charcoal-burners,  coal- 
handlers,  firemen,  chimney-sweeps,  foundry-men,  lead-pencil 
makers,  etc.  Chronic  bronchial  catarrhs  are  most  frequent, 
while  phthisis  and  emphysema  are  almost  absent  from  the  list 
of  diseases  affecting  these  workmen.  Dr.  W.  B.  Canfield  has 
reported  an  interesting  case  of  pneumonoconiosis  in  which  there 
was  coincident  bacillary  phthisis.1  The  table  on  page  208  shows 
that  the  expectation  of  life  of  foundry-men,  furnace-men,  fire- 
men, and  chimney-sweeps  is  much  below  the  average. 

Metallic  dust  is  inhaled  by  blacksmiths,  nailers,  cutlers,  lock- 
smiths, file-cutters,  cutlery-  and  needle-  polishers,  etc.     While 

1  Trans.  Med.  and  Chir.  Fac,  Md.,  1889. 


222  TEXT-BOOK   OF   HYGIENE. 

in  this  class  of  workmen  cases  of  bronchitis  and  pneumonia 
are  relatively  frequent,  much  the  largest  proportion  suffer  from 
phthisis.  A  table  compiled  by  Hirt  shows  that  out  of  the  total 
number  of  sick  in  the  different  classes  of  workmen  the  cases  of 

phthisis  were : — 

62.2  per  cent,  for  file-cutters, 
69.6        "  "    neecfle-polishers, 

40.4        "  "    grinders, 

12.2        "  "    nailers. 

The  Massachusetts  table  gives  the  average  duration  of  life 
for  blacksmiths  at  53.26  years,  of  nail-makers  at  41.49  years, 
and  of  cutlers  at  39.21  years.  The  needle-polishers  at  Sheffield, 
as  already  stated  (page  210),  have  only  an  average  duration  of 
life  of  30.66  years.  In  this  work  and  that  of  grinding  knives, 
scissors,  and  similar  articles,  the  metallic  dust  is  mixed  with 
mineral  dust  (particles  of  silica  from  the  grindstone).  This 
mixture  seems  to  be  much  more  deleterious  than  metallic  dust 
alone,  as  shown  by  the  shorter  average  duration  of  life  and  the 
enormous  percentage  of  cases  of  consumption. 

Mineral  dust  is  inhaled  by  the  workmen  in  a  large  number 
of  different  industries.  The  grinders  in  the  ground-glass  factories 
suffer  most  severely.  Hirt  found  the  average  duration  of  life  in 
grinders  who  began  this  occupation  after  their  25th  year  to  be 
42.50  years,  while  in  those  who  began  at  the  age  of  15  the 
average  duration  was  30  years. 

Millstone  cutting  is  also  a  very  dangerous  occupation.  Pea- 
cock1 gives  the  average  age  of  these  workmen  at  24.1  years. 
Stone-cutters  generally  suffer  frequently  from  phthisis,  probably 
largely  in  consequence  of  the  constant  inhalation  of  the  mineral 
dust  produced  during  their  work.  The  Massachusetts  table  gives 
the  average  age  at  death  of  these  workmen  at  40.90  years, 
while  Hirt's  table  gives  a  much  lower  age,  namely  36.3  years. 
Potters  and  porcelain-makers  are  exposed  to  similar  dangers 
from  their  occupation,  but  to  a  much  less  degree.     The  table  on 

1  Quoted  by  Merkel,  in  von  Pettenkofer  und  Ziemssen's  Handbuch  der  Hygiene,  II  Th., 
4  Abtb.,  p.  197. 


DISEASES   DUE   TO   INHALATION    OF    DUST.  223 

page  208  gives  the  average  age  at  death  at  56.67  years, — rather 
a  high  average. 

Slaters  and  workmen  in  slate-quarries  suffer  in  a  large  pro- 
portion of  cases  from  chronic  pneumonia,  and  die  at  a  compara- 
tively early  age. 

Masons  and  carpenters  have  an  average  duration  of  life  of 
50.33  and  53.33  years,  respectively.  One-third  of  all  the  diseases 
from  which  they  suffer  affect  the  respiratory  organs. 

Gussenbauer  has  reported  a  very  interesting  series  of  cases 
of  a  peculiar  inflammatory  affection  of  the  diaphyses  of  the  long 
bones  in  the  artisans  who  are  engaged  in  the  manufacture  of 
pearl  buttons. 

Gem-finishers  are  exposed  not  only  to  the  inhalation  of 
dust,  but  to  poisonous  gases  (carbon  monoxide)  and  vapors 
(lead).     The  proportion  of  sickness  among  them  is  very  high. 

Vegetable  Dust. — The  workmen  compelled  to  inhale  vege- 
table dust  are  those  who  work  in  tobacco,  cotton-operatives, 
flax-dressers,  paper-makers,  weavers,  wood-turners,  millers,  and 
laborers  in  grain-elevators. 

Workmen  in  tobacco  usually  suffer,  within  a  few  weeks 
after  beginning  work,  from  a  nasal,  conjunctival,  and  bronchial 
catarrh,  which  soon  passes  off,  as  the  mucous  membranes  seem 
to  become  accustomed  to  the  irritation.  Nausea  is  also  frequent 
at  first,  due  probably  to  the  absorption  of  small  quantities  of 
nicotine.  Females  exposed  to  tobacco-dust  usually  suffer  from 
digestive  and  nervous  troubles.  They  are  also  said  to  abort 
frequently. 

Dr.  R.  S.  Tracy,1  as  a  result  of  his  observations  among 
cigar-makers  in  New  York,  states  that  the  fecundity  of  these 
people  is  much  less  than  the  average.  Three  hundred  and 
twenty-five  families  visited  had  only  465  children,  an  average 
of  1.43  to  each  family.  Dr.  Tracy  is  inclined  to  attribute  this 
to  the  frequent  abortions  that  occur  among  the  females  exposed  to 
the  inhalation  of  tobacco-dust.     According  to  the  Massachusetts 

1  Buck's  Hygiene  and  Public  Health,  vol.  ii,  p.  62. 


224  TEXT-BOOK    OF    HYGIENE. 

table,  cigar-making  is  an  unfavorable  occupation,  the  average 
a^e  at  death  beino-  38.36  years. 

Cotton-operatives,  flax-dressers,  weavers,  and  workmen  in 
paper-mills  are  subject  to  various  diseases  of  the  respiratory 
organs.  Coetsem,  as  long  ago  as  1836,  described  a  peculiar 
pulmonary  affection  among  cotton-operatives,  which  he  termed 
pneumonie  cotonneuse.  The  observation  does  not  seem  to  have 
been  verified  by  others ;  at  all  events,  the  author  is  unable  to 
find  any  other  record  of  a  similar  affection  in  the  literature  of 
the  subject.  Among  weavers  the  mortality  from  phthisis  is 
comparatively  high.  Among  paper-makers  Hirt  found  an 
average  duration  of  life  of  37. 6  years.  The  people  who  sort 
rags  are  liable  to  a  fatal  infectious  disease,  "rag-sorters'  disease" 
(Hademkrankheit1),  which  resembles  in  all  respects,  and  is  prob- 
ably nothing  less  than,  anthrax.  No  cases  have  been  reported 
in  this  country,  but.  as  the  importation  of  rags  from  abroad  is 
carried  on  to  a  considerable  extent,  no  apology  is  believed  to  be 
necessary  for  calling  attention  to  it.  The  *;  wool-sorters'  disease," 
to  which  attention  has  recently  been  called  in  England,  is  doubt- 
less similar  in  its  nature. 

Millers  suffer  in  a  large  proportion  of  cases  from  pulmonary 
affections,  especially  bronchial  catarrh  and  pneumonia.  Accord- 
ing to  Hirt,  20.3  per  cent,  of  all  the  diseases  of  these  workmen 
are  pneumonias,  9.3  per  cent,  bronchial  catarrhs,  10.9  per  cent, 
phthisis,  and  1.9  per  cent,  emphysema.  The  average  duration 
of  life  is  -45.1  years.  The  Massachusetts  table  gives  57.14  years, 
— a  very  much  more  favorable  exhibit. 

The  laborers  in  grain-elevators  are  compelled  to  inhale  a 
very  irritating  dust,  which  causes  acute  and  chronic  catarrhs  of 
the  respiratory  organs.  Dr.  T.  B.  Evans,  of  Baltimore,  has 
reported  a  series  of  cases  of  catarrhal  pneumonia  in  these  work- 
men, which  were  characterized  by  some  very  peculiar  features. 
Brush-making,  according  to  the  statistics  of  Hirt,  is  a  very  dan- 
gerous occupation.     Nearly  one-half  of  the  deaths  among  brush- 

1  See  article  by  Soyka,  Realencyclopaedie  d.  ges.  Heilk,  Bd.  VI,  p.  165. 


DISEASES   DUE    TO    POISONOUS    SUBSTANCES.  225 

makers  are  from  phthisis,  due,  in  great  measure,  to  the  inhalation 
of  the  sharp  fragments  of  bristles  produced  in  trimming  the 
brushes.  In  the  Massachusetts  table  the  average  duration  of 
life  is  given  at  43.11  years. 

III. DISEASES    DUE    TO    THE    ABSORPTION    OR    LOCAL   ACTION    OF 

IRRITATING    OR    POISONOUS    SUBSTANCES. 

Arsenic  is  used  in  the  manufacture  of  green  pigments  and 
for  various  other  purposes  in  the  arts.  In  the  preservation  of 
furs  and  in  taxidermy  it  finds  extensive  use.  In  the  prepara- 
tion of  the  pigment  known  as  Paris  green  the  workmen  are 
frequently  entirely  covered  by  a  layer  of  the  poisonous  salt.  The 
poisonous  symptoms  occur  in  consequence  of  the  absorption  of 
the  poison  through  the  skin  or  from  its  local  action,  and  but 
rarely  on  account  of  inhalation  of  vapors  or  dust  in  which  it  is 
contained.  The  most  marked  symptoms  are  chronic  gastric 
catarrh,  superficial  erosions  in  the  mouth,  dry  tongue,  thirst,  and 
a  burning  sensation  in  the  throat.  These  symptoms  may  con- 
tinue for  months,  or  even  years,  and  gradually  produce  a  com- 
plete breaking  down  of  nutrition  and  the  vital  powers.  Violent 
itching  skin  eruptions  of  an  eczematous  character  are  not  infre- 
quent complications  of  the  internal  symptoms. 

Lewin  has  described  a  localized  pigmentation  of  the  skin 
in  workmen  (engravers)  in  silver.  The  left  hand  is  especially 
affected.  The  occurrence  of  the  affection  is  explained  by  the 
numerous  slight  injuries  of  the  hands  by  the  graver's  tools  and. 
the  local  absorption  and  decomposition  of  the  silver. 

Phosphorus  produces  two  classes  of  effects  in  persons  sub- 
jected to  its  influence.  The  milder  effects  are  produced  by  the 
inhalation  of  the  fumes  of  the  substance,  and  are  limited  to 
digestive  disturbances  and  diseases  of  the  pulmonary  organs. 
The  severer  symptoms  are  only  observed  among  the  employes 
in  match-factories,  and  are  due  to  the  local  action  of  the  phos- 
phorus upon  the  tissues  affected. 

The  characteristic  disease  produced  by  phosphorus  is  a 

15 


226  TEXT-BOOK    OF    HYGIENE. 

painful  periostitis  of  the  lower  or  upper  jaw.  The  limitation 
of  the  affection  to  this  locality  is  believed  to  be  due  to  the  action 
of  the  phosphorus  dissolved  in  the  saliva.  The  fact  that  the 
lower  jaw,  with  which  the  saliva  comes  more  thoroughly  in 
contact,  is  most  frequently  affected  seems  to  indicate  that  this 
view  is  the  correct  one.  The  disease  begins,  on  an  average,  five 
years  after  the  beginning  of  the  employment.  Hirt  estimates 
the  proportion  of  employes  in  match-factories  attacked  at  11  to 
12  per  cent.  The  first  symptom  of  the  disease  is  toothache, 
soon  extending  to  the  jaw.  The  cervical  glands  swell  up ;  the 
gums  become  reddened  and  spongy ;  abscesses  form  about  the 
diseased  teeth,  from  which  large  quantities  of  thin,  offensive  pus 
are  discharged.  Examination  with  a  sound  reveals  carious, 
nodulated  bone.  The  cheeks  become  swollen,  erysipelatous, 
and  may  suppurate  and  discharge  pus  externally. 

Hutchinson  has  reported  a  case  in  which  the  long-continued 
internal  administration  of  phosphorus  as  a  medicine  produced 
maxillary  necrosis. 

The  destruction  of  the  soft  tissues  continues  until  resection 
of  the  jaw  is  finally  undertaken  and  the  disease  checked  by 
surgical  interference,  and  removal  of  the  patient  from  the  influ- 
ence of  the  pernicious  substance. 

Dr.  J.  Ewing  Mears  reports1  16  cases  of  phosphorus  ne- 
crosis. He  concludes  "  that  the  antidotal  powers  of  turpentine 
have  been  established,  both  in  neutralizing  the  effects  of  the 
poison  upon  operatives  during  their  work  and  also  in  the  treat- 
ment of  the  early  stage  of  the  disease.  The  disease  is  to  be 
prevented  by  the  adoption  of  thorough  methods  of  ventilation, 
stringent  rules  with  regard  to  cleanliness,  and  the  free  disen- 
gagement of  the  vapors  of  turpentine  in  all  the  apartments  of 
factories  in  which  the  fumes  of  phosphorus  escape." 

In  the  manufacture  of  quinine  a  troublesome  eczema  is 
caused  in  about  90  per  cent,  of  the  employes.  It  seems  to  be 
due  to  emanations  given   off  from   the  boiling  solutions.     It 

1  Trans.  Am.  Surg.  Association,  1887. 


DISEASES   DUE   TO   ELEVATED    OR   VARIABLE   TEMPERATURE.       227 

begins  with  intense  itching,  followed  by  swelling  and  the  forma- 
tion of  vesicles,  which  soon  burst  and  form  crusts.  There  is 
considerable  fever  when  the  swelling  is  great.  It  is  said  that 
blondes  are  more  frequently  affected  than  those  of  dark  com- 
plexion.    The  disease  soon  disappears  if  the  work  is  given  up. 

The  workmen  engaged  in  the  manufacture  of  bichromate 
of  potassium  are  said  to  suffer  from  an  ulceration  of  the  nasal 
mucous  membrane  very  similar  to  that  already  described  as  due 
to  the  vapors  of  hydrochloric  acid  (p.  212).  Rapidly  spreading, 
deep  ulcers  are  also  said  to  form  if  the  bichromate  comes  in 
contact  with  abraded  surfaces  of  the  skin. 

The  strong  alkali  handled  by  tanners  frequently  produces 
fissured  eczemas  of  the  hands,  which  are  painful  and  often  diffi- 
cult to  cure. 

The  workmen  in  petroleum  refineries  frequently  suffer  from 
acneiform  or  furuncular  eruptions. 

Among  glass-blowers,  syphilis  is  frequently  communicated 
by  an  infected  mouth-piece  which  is  used  by  the  men  in  turn. 

TV. DISEASES   DUE    TO   EXPOSURE    TO   ELEVATED    OR  VARIABLE 

TEMPERATURE    OR   ATMOSPHERIC   PRESSURE. 

Cooks  and  bakers  are  exposed  almost  constantly  to  a  high 
temperature,  which  produces  an  unfavorable  influence  upon 
health  and  predisposes  them  to  diseases  of  various  kinds.  The 
Massachusetts  table  shows  that  cooks  have  a  much  shorter 
duration  of  life  than  bakers,  although  the  statistics  of  both 
trades  are  unfavorable. 

The  prevailing  diseases  among  cooks  and  bakers  are  rheu- 
matism and  eczematous  eruptions,  generally  confined  to  the 
hands,  forearms,  and  face. 

Blacksmiths,  founders,  and  firemen  suffer  from  the  intense 
heat  to  which  they  are  exposed,  in  addition  to  the  inhalation  of 
coal-dust,  as  has  already  been  pointed  out.  The  stokers  in  the 
engine-rooms  of  steam-ships  suffer  especially  from  the  excessively 
high  temperature  to  which  they  are  subjected  by  their  occupation. 


228  TEXT-BOOK    OF   HYGIENE. 

A  form  of  heart-weakness,  described  by  Levick  as  "  fireman's 
heart,"  is  prevalent  among  them. 

Sailors,  farmers,  coachmen,  car-drivers,  and  teamsters  are 
subjected  to  stress  of  weather,  changes  of  temperature,  and 
storms.  They  suffer  frequently  from  rheumatism,  acute  bron- 
chitis, pneumonia,  and  Bright's  disease.  Car-drivers  are  said 
also  to  suffer  from  painful  swelling  of  the  feet,  varicose  veins 
and  ulcers,  and  mild  spinal  troubles.1 

Sun-stroke  is  not  confined  to  any  class  of  artisans,  but 
persons  who  perform  very  hard  labor,  especially  in  a  confined 
atmosphere,  suffer  most  frequently. 

The  effects  of  compressed  air  on  workmen  in  tunnels  and 
deep  mines  has  already  been  referred  to.2  The  most  serious 
symptoms  occur  not  when  the  individual  is  subjected  to  the 
increased  pressure,  but  when  the  pressure  is  too  rapidly  dimin- 
ished. 

V. DISEASES   DUE   TO   THE   EXCESSIVE   USE   OF    CERTAIN   ORGANS. 

The  prevalent  belief  that  the  overuse  of  the  intellectual 
faculties  is  a  frequent  cause  of  mental  disease  is  not  borne  out 
by  facts.  Men  and  women  who  perform  an  amount  of  mental 
work  regarded  by  most  persons  as .  excessive  have,  in  spite  of 
this,  a  long  duration  of  life. .  There  are  no  exact  statistics  upon 
this  subject,  but  Caspar,  half  a  century  ago,  made  the  following 
estimate  of  the  average  duration  of  life  among  professional  men  : 
Clergymen  live  65;  merchants,  62.4 ;  officials,  61.7  ;  lawyers, 
58.9 ;  teachers,  56.9,  and  physicians,  56.8  years.  In  the  table 
on  page  209  the  figures  are  somewhat  less  favorable,  although 
corresponding  in  general  with  those  of  Caspar.  Hence,  it  is 
seen  that,  of  professional  men,  those  whose  occupation  compels 
the  exercise  of  high  mental  powers  have  a  higher  duration  of 
life  than  any  other  class,  except  farmers  and  mechanics  engaged 
actively  out  of  doors.  Those  professional  occupations  only 
which   necessitate  a  more  or   less  irregular  mode  of  life  and 

»  A.  McL.  Hamilton  in  Report  New  York  Board  of  Health,  p.  444, 1873. 
3  Chapter  I,  p.  12. 


DISEASES   DUE   TO   A   SEDENTARY   LIFE.  229 

frequent  subjection  to  physical  exhaustion  and  dangers  from 
contagious  disease,  such  as  the  work  of  physicians  and  journal- 
ists, make  an  unfavorable  showing  in  the  statistics.  The  prop- 
osition may  be  laid  down  that  it  is  not  mental  activity,  however 
great,  but  mental  worry  that  tends  to  the  abbreviation  of  life. 

The  occupation  of  a  tea-taster  is  said  to  produce  a  peculiar 
nervous  condition,  manifested  in  muscular  tremblings,  etc., 
which  compels  the  individual  to  give  up  the  work  in  a  few  years. 

Persons  who  test  the  quality  of  tobacco,  an  occupation  corre- 
sponding to  that  of  tea-taster,  are  said  to  suffer  from  nervous  symp- 
toms, which  may  include  amaurosis  and  other  grave  affections. 

Those  persons  who  are  compelled  to  use  their  eyes  con- 
stantly upon  minute  objects  frequently  suffer  from  defective 
vision.  So  engravers,  watch-makers,  and  seamstresses  are  liable 
to  near-sightedness,  amaurosis,  and  irritation  of  the  conjunctiva. 
Public  speakers  and  singers  frequently  suffer  from  catarrhal  or 
even  paretic  conditions  of  the  throat,  which  usually  disappear 
on  relinquishing  the  occupation  for  a  time. 

Telegraph  operators  and  copyists  suffer  from  a  peculiar 
convulsive  affection  of  the  fingers,  called  "writers'  cramp." 
Cigar-makers  are  also  said  to  suffer  from  a  similar  cramp  of 
the  fingers  used  in  rolling  cigars.  Performers  on  wind  instru- 
ments are  liable  to  pulmonary  emphysema,  on  account  of  the 
pressure  to  which  the  lungs  are  frequently  subjected.  Boiler- 
makers often  suffer  from  deafness,  in  consequence  of  their 
constant  existence  in  an  atmosphere  in  a  state  of  continual  violent 
vibration.  The  affection  is  generally  recognized  as  "  boiler- 
makers'  deafness."  Dr.  C.  S.  Turnbull  has  reported  several 
cases  of  "  mill-operatives'  deafness."  Its  characteristic  is  an 
inability  to  hear  distinctly  except  during  a  noise. 

VI. DISEASES   DUE   TO    A   CONSTRAINED    ATTITUDE   AND 

SEDENTARY    LIFE. 

It  is  probable  that  the  large  mortality  and  morbility  rate 
of  persons  whose  occupations  keep  them  confined  within  doors 


230  TEXT-BOOK   OF   HYGIENE. 

are  due,  next  to  the  defective  ventilation,  to  the  constrained 
attitude  which  most  of  them  necessarily  assume.  Thus,  carvers, 
book-binders,  engravers,  jewelers,  printers,  shoe-makers,  book- 
keepers, and  cigar-makers  all  have  a  low  average  duration  of 
life.  It  is  found,  likewise,  that  many  of  these  artisans  suffer 
most  from  pulmonary  and  digestive  troubles,  among  the  former 
being  phthisis,  and  among  the  latter  constipation,  dyspepsia,  and 
haemorrhoids. 

YII. DISEASES    FROM    EXPOSURE    TO    MECHANICAL    VIOLENCE. 

It  will  be  seen,  by  reference  to  the  table  on  page  209,  that 
all  persons  whose  occupations  involve  an  intimate  contact  with 
machinery,  and  in  the  pursuit  of  which  accidents  frequently 
happen,  have  a  short  duration  of  life.  Persons  liable  to  these 
dangers  are  machinists,  operatives  in  factories,  workmen  in 
powder-mills,  baggage-masters,  brakemen,  drivers,  engineers, 
firemen,  and  other  workmen  on  railroads.  Aside  from  the 
diseases  to  which  some  of  these  classes  are  liable  in  consequence 
of  exposure  to  variable  atmospheric  conditions,  the  grave  acci- 
dents to  which  they  are  so  frequently  exposed  render  their 
occupations  extremely  dangerous.  Brakemen  on  freight  rail- 
roads, for  example,  are  classed  by  insurance  companies  as  the 
most  hazardous  "  risks,"  and  some  companies  refuse  to  take  them 
at  all.  The  table  on  page  209  tends  to  confirm  the  conclusion  of 
the  insurance  companies,  for,  excluding  the  class  of  "  students," 
which,  for  manifest  reasons,  cannot  be  used  as  a  comparison, 
brakemen  have  the  shortest  average  duration  of  life  of  all  the 
occupations  noted  in  the  table. 

[The  student  is  referred,  for  more  complete  information  on 
the  subjects  considered  in  the  foregoing  chapter,  to  the  following 
works : — 

L.  Hirt,  Die  Krankheiten  der  Arbeiter. — Eulenburg,  Handbuch  der 
Gewerbekygiene. — Layet,  Hygiene  des  Professions  et  des  Industries.] 


CHAPTER  X. 

Military  and  Camp  Hygiene. 

The  subjects  embraced  in  this  chapter  can  be  most  con- 
veniently arranged  under  the  following  heads : — 

I.  The  Soldier  and  his  Training.  IV.  The  Dwelling  of  the  Soldier. 

II.  The  Food  of  the  Soldier.  V.  Camp  Diseases. 

III.  The  Clothing  of  the  Soldier.  VI.  Civilian  Camps. 

I. THE    SOLDIER   AND   HIS   TRAINING. 

The  relations  existing  among  different  nations  at  the  present 
time  require  that  a  standing  army  of  greater  or  less  number  be 
maintained  by  each  for  the  common  safety.  This  being  the 
case,  it  needs  no  argument  to  prove  that  such  an  army  should 
be  composed  of  the  best  material  available  in  order  that  it  may 
be  depended  upon  for  defense  or  offense  when  necessity  demands 
that  it  should  be  called  into  active  service. 

Hammond  says  with  truth1  that  "  a  weak,  malformed,  or 
sickly  soldier  is  not  only  useless  but  a  positive  incumbrance  "  to 
an  army.  It  is  of  the  first  importance,  therefore,  to  exclude 
from  the  military  service,  by  a  rigorous  physical  examination,  all 
individuals  whose  physical  condition  is  defective,  who  are  either 
suffering  from  or  predisposed  to  disease. 

The  foremost  authorities  on  military  hygiene  are  agreed 
that  no  recruit  should  be  enlisted  for  actual  service  before  the 
20th  year.  In  the  English  army  the  lowest  age  at  present  is 
19  years ;  in  Germany,  20  years ;  in  France,  20  years  for  actual 
service  (recrues),  18  years  for  enlistment  (engages);  and  in  the 
United  States,  21  years.  The  limit  of  age  upward  in  the  latter 
army  is  45  years,  except  in  cases  of  re-ehlistments.  The  height 
of  recruits  must  be  at  least  165  centimetres;  minimum  chest 

1  Hygiene,  p.  19.    Philadelphia,  1863. 

(231) 


232  .  TEXT-BOOK   OF   HYGIENE. 

measurement  75  centimetres,  with  at  least  5  centimetres'  expan- 
sion ;  and  weight  from  54  to  81  kilogrammes.  In  the  cavalry 
service  the  maximum  weight  is  75  kilogrammes.  Every  recruit 
must  be  vaccinated  before  enlistment. 

The  physical  examination  of  recruits  before  enlistment 
must  be  made  by  a  medical  officer,  whose  decision,  in  the  United 
States  army,  is  definitive.  In  the  German  army  the  decision  of 
the  medical  officer  is  not  final,  but  subject  to  revision  by  the 
recruiting  officer,  who  may,  if  he  sees  fit,  overrule  the  medical 
officer's  opinion  and  enlist  a  man  who  has  been  decided  to  be 
unqualified  for  the  military  service.  In  this  and  various  other 
respects,  such  as  pay,  rank,  and  effective  power,  the  Medical 
Staff  of  the  United  States  Army  has  many  advantages  over  that 
of  most  foreign  armies. 

II. — THE  FOOD   OF   THE   SOLDIER. 

The  army  ration  of  the  United  States,  which  is  given  below, 
was  fixed  by  regulations  before  the  more-recent  researches  of 
Professor  Voit  on  nutrition  were  completed.  The  ultimate  com- 
position, which  yields  142  grammes  proteids,  116  grammes  fats, 
and  435  grammes  carbohydrates,  shows  an  excess  of  fats  and 
deficiency  of  carbohydrates.  Table  XXI  shows  the  daily  allow- 
ance for  each  soldier  : — 

Table  XXI. 
342  grammes  pork  or  bacon,  or 


567 

a 

fresh  beef. 

454 

ic 

hard  bread,  or 

566 

u 

flour. 

68 

u 

beans  or  peas,  or 

45 

u 

rice  or  hominy. 

45 

u 

green  coffee. 

IT 

it 

salt. 

68 

it 

sugar. 

To  this  is  also  added  vinegar,  pepper,  and  tea  in  place  of 
coffee.  Although  the  regular  food-allowance  in  the  United  States 
army  is  liberal,  and  is  largely  in  excess  of  the  needs  of  the  soldier 


THE    CLOTHING    OF    THE    SOLDIER.  233 

in  garrison,  medical  officers  generally  agree  that  in  active  service 
it  is  insufficient  in  quantity  and  not  sufficiently  varied. 

The  money  value  of  each  of  the  above  articles  in  the  ration 
is  fixed  by  the  government,  and  may  be  drawn  instead  of  certain 
of  the  articles,  and  other  articles  of  food  purchased  and  thus 
the  dietary  varied.  The  money  so  drawn  constitutes  what  is 
known  as  the  "  company  fund."  In  the  hands  of  a  judicious 
commanding  officer,  the  company  fund  can  be  made  a  source 
of  great  benefit  and  comfort  to  the  men,  but  that  it  is  at 
times  mismanaged  or  misapplied  is  well  known  to  army  sur- 
geons. 

Aside  from  the  insufficient  quantity  and  variety  of  food 
furnished  to  soldiers,  the  cooking,  especially  in  temporary  camps, 
is  often  defective  and  causes  digestive  derangements  and  con- 
sequent innutrition.  A  good  cook  should  be  attached  to  every 
company. 

III. THE  CLOTHING  OF  THE  SOLDIER. 

The  clothing  of  the  United  States  soldier  is  tolerably  well 
adapted  to  its  uses.  It  is  generally  well  made,  and  of  good, 
serviceable  material.  The  only  exception  that  can  be  made  with 
reason  is  that  the  foot-gear  is  not  made  to  individual  measure, 
and  hence  peculiarities  of  shape  of  the  feet  cannot  be  taken 
account  of.  For  this  reason  painful  affections  of  the  feet,  due  to 
ill-fitting  boots  or  shoes,  are  of  frequent  occurrence. 

When  on  a  march,  the  soldier  carries  his  extra  clothing 
packed  in  a  knapsack  and  strapped  upon  the  back.  His 
blankets  and  great-coats  are  rolled  into  a  cylinder  and  strapped 
upon  the  knapsack.  The  weight  each  soldier  has  thus  to  carry, 
in  addition  to  his  arms  and  ammunition,  amounts  to  considerable. 
There  is  reason  to  believe  that  the  pressure  produced  by  the 
straps  of  a  heavy  knapsack  may  cause  not  only  discomfort  but 
actual  disease.  It  is  believed  by  many  officers  that  the  knapsack 
could  be  abolished  with  advantage,  and  the  extra  clothing  rolled 
up  in  the  blanket,  or  a  water-proof  sheet,  and  slung-  over  the 
left  shoulder. 


234  TEXT-BOOK   OF   HYGIENE. 

IV. — THE   DWELLING   OF   THE    SOLDIER. 

Soldiers  are  generally  housed  either  in  barracks,  huts,  or 
tents.  The  former  are  usually  the  habitation  of  the  soldiers 
in  garrisons  or  permanent  camps,  while  huts  or  tents  are 
used  for  the  purpose  of  sheltering  the  occupants  of  temporary 
camps. 

Barrachs. — A  military  barrack  is  a  one-storied  building 
constructed  of  stone,  wood,  or  iron,  or  a  combination  of  these 
materials.  The  general  plan  of  the  barrack  comprises  a  large 
room  for  the  beds  of  the  soldiers,  one  or  more  smaller  rooms 
for  the  non-commissioned  officers  of  the  company  or  squad,  and 
a  wash-room.  The  sleeping-room  of  the  soldier  is  also  his  living- 
or  day-  room.  It  is  evident,  therefore,  that  sufficient  air-space 
and  good  ventilation  must  be  provided  if  the  soldier's  health  is  to 
be  maintained.  In  England,  17  cubic  metres  are  recommended 
for  the  initial  air-space.  In  the  new  barracks  constructed  in 
France  according  to  the  plans  of  M.  Toilet,  22  cubic  metres  are 
allowed  to  each  occupant. 

The  special  points  of  distinction  of  the  system  of  Toilet,  of 
which  Schuster  says  that  "to  it  belongs  the  future  of  barrack 
construction,"  are  :  The  frame  of  the  building  is  of  light-iron 
ribs ;  the  interspaces  are  walled  up  with  bricks  or  stone ;  the 
roof  is  slate  ;  the  ceiling  is  arched,  and  all  corners  are  rounded  to 
prevent  lodgment  of  dust.  Ventilation  is  provided  by  openings 
in  the  walls  at  the  edge  of  the  roof  for  the  entrance  of  fresh  air, 
and  by  ridge  ventilators. 

In  France,  barracks  have  been  built  according  to  Toilet's 
system  at  Bourges,  Cosne,  Macon,  and  Autun.  Although  occu- 
pied but  a  short  time,  it  appears  that  the  health  of  the  soldiers 
remains  better  in  them  than  in  the  barracks  constructed  on  the 
old  style.  The  system  would  seem  also  especially  to  lend  itself 
to  the  construction  of  hospitals.  The  wash-  and  bath-  rooms  of 
the  barracks  should  be  so  arranged  as  to  encourage  the  soldier 
to  cleanliness.  Where  the  only  lavatory  in  a  barrack  is,  as 
the  author  has  seen  it,  an  open  porch,  men  are  not  likely  to 


THE   DWELLING   OF   THE    SOLDIER.  235 

spend  much  time  in  cold  weather  in  washing  their  faces  and 
hands,  to  say  nothing  of  the  rest  of  their  bodies. 

The  kitchen  and  dining-room  should  be  detached  from  the 
building  serving  as  quarters ;  otherwise  the  odors  of  the  cooking 
will  pervade  the  building. 

The  sinks  or  latrines  should  be  placed  at  some  distance  from 
the  quarters  and  kitchen,  and  out  of  the  line  of  prevailing  winds. 
The  writer  has  personal  knowledge  of  a  permanent  military  post 
within  a  few  miles  of  the  city  of  Washington,  where,  only  a  few 
years  ago  (and,  for  aught  known  to  the  contrary,  at  the  present 
day),  "  the  rear,"  or  place  of  depositing  excrement,  was  about 
70  metres  distant  from  the  kitchen  and  men's  quarters,  and 
directly  in  line  (to  leeward)  with  the  prevailing  winds ! 

Before  erecting  any  buildings  it  is,  of  course,  necessary  to 
endeavor  to  secure  a  clean  and  dry  subsoil.  Attention  is  called  to 
the  principles  underlying  the  construction  of  dwellings,  Chap.  VI. 

Tents  and  Huts. — The  tents  used  in  the  army  are  the  hos- 
pital-tent, the  officers'  wall- tent,  the  A -tent,  and  the  shelter- 
tent,  which  is  a  modification  of  the  last.  The  conical,  or  Sibley 
tent,  which  was  frequently  seen  in  camps  in  the  early  part  of 
the  war  between  the  States,  has  gone  out  of  use.  Soldiers  give 
the  preference  to  the  shelter  tent,  which  is  light,  each  man's 
piece  weighing  only  1.18  kilogrammes.  Two  pieces  being 
joined  together  by  buttons  and  button-holes,  and  thrown  over  a 
ridge-pole  supported  upon  uprights,  and  the  four  corners  fast- 
ened to  pegs  driven  into  the  ground,  form  a  tent  1.20  metres 
high,  1.65  metres  long,  and  having  a  spread  at  the  base  of 
between  1.8  and  2.1  metres.  Such  a  tent  will  form  a  comfort- 
able shelter  for  two  men,  unless  there  should  be  strong  winds  or 
driving  rains,  when  the  ends  could  be  closed  by  blankets,  brush, 
or  an  extra  piece  of  shelter-tent.  The  uprights  and  ridge  are 
steadied  by  short  guy-ropes,  one  of  which  is  furnished  with 
each  piece  of  the  tent. 

In  winter,  especially  when  camps  of  more  or  less  perma- 
nence are  formed,   the  soldiers  usually  build  log  huts.     The 


236 


TEXT-BOOK   OF   HYGIENE. 


interstices  between  the  logs  are  plastered  up  with  mud  or  clay, 
and  the  roof  is  formed  of  canvas,  generally  several  pieces  of 
shelter  tent  joined  together. 

The  ground  around  the  tent  or  hut  should  be  trenched  in 
order  to  carry  off  the  rain-fall. 

Cleanliness  within  and  around  tents  or  huts  is  of  the  first 
importance,  and  should  be  enforced  in  all  camps  by  the  proper  au- 
thority. Military  authorities  have  long  since  learned  that  in  the 
matter  of  cleanliness  of  body,  clothing,  or  surroundings  voluntary 
action  on  the  part  of  the  soldier  cannot  be  relied  upon.  Frequent 
and  thorough  inspections  will  alone  secure  proper  cleanliness. 

V. CAMP   DISEASES. 

The  soldier's  profession  has  been  aptly  characterized  by 
Euskin  as  "  the  trade  of  being  slain."  In  the  late  war  between 
the  States,  the  total  deaths  of  the  Federal  army  numbered  359,496, 
— over  15  per  cent,  of  the  entire  number  of  enlistments.  Of  this 
number,  however,  224,586  (nearly  two-thirds)  died  from  disease, 
while  the  remaining  134,910  (a  small  fraction  over  one- third)  were 
killed  in  battle  or  died  from  the  effects  of  wounds.  The  colored 
troops  especially  suffered  greatly  from  the  effects  of  disease. 

Diarrhoea  and  Dysentery. — The  most  fatal  diseases  of  camp 

life,  especially  in  time  of  war,  are  diarrhoea  and  dysentery.    The 

statistics  of  the  Federal  army  during  the  late  war  are  given  in 

the  following  table1:  — 

Table  XXII. 

Total  Deaths  from  Diarrhoea  and  Dysentery  in  the  U.  8.  Army,  from  May  1,  1861, 

to  June  30,  1866. 


White  Troops,  from 

May  1,  1861.  to  June 

30,  1866. 

Colored  Troops, 
from  July  1,  1863, 
to  June  30, 1866. 

Total. 

Acute  Diarrhoea   .... 
Chronic  Diarrhoea    .    .    . 
Acute  Dysentery  .... 
Chronic  Dysentery  .    .    . 

Cases. 
1,155,226 

170,488 

233,812 

25,670 

Deaths. 
2,923 

27,558 
4,084 
3,229 

Cases. 

113,801 
12,098 
25,259 

2,781 

Deaths 
1,368 
3,278 
1,492 
626 

Cases. 

1,269,027 

182,586 

259,071 

28,451 

Deaths 

4,291 

30,836 

5,576 
3,855 

Total 

1,585,196 

37,794 

153,939 

6,764 

1,739,135 

44,558 

1  Medical  and  Surgical  History  of  the  War,  second  medical  volume,  p.  2. 


CAMP   DISEASES.  237 

Owing  to  the  fact  that  a  considerable  number  of  deaths 
were  reported  without  assigning  any  cause,  Dr.  Woodward  esti- 
mates the  total  number  of  deaths  from  the  above  diseases  at 
57,265,  or,  in  the  proportion  of  one  death  from  diarrhoea  and 
dysentery  to  three  and  one-half  deaths  from  all  diseases.  Among 
the  prisoners  of  war  held  by  the  Confederate  States  in  Anderson- 
ville  prison,  where  tolerably  complete  records  were  kept,  more 
than  half  the  total  deaths  were  from  diarrhoea  and  dysentery, 
while  the  ratio  of  deaths  to  cases  of  the  above  two  diseases  was  a 
fraction  over  76  per  cent.  This  frightful  mortality  from  these 
two  diseases,  both  in  the  prisons  and  among  the  armies  in  the 
field,  is  principally  due  to  the  insanitary  conditions  surrounding 
the  soldiers.  Where  the  demands  of  hygiene  were  especially 
ignored ;  where  the  food  was  bad  in  quality,  or  badly  cooked  ; 
the  water  impure;  the  soil  polluted  by  excreta  and  other  filth; 
where  the  men  were  exposed  to  stress  of  weather  or  to  a  paludal 
atmosphere; — under  these  conditions,  the  above  diseases  of  the 
intestines  prevailed  in  their  greatest  extent  and  most  fatal 
degree. 

Malarial  Fevers. — The  diseases  due  to  the  paludal  poison 
are  exceedingly  frequent  among  soldiers  encamped  in  malarial 
sections.  During  the  Civil  War  a  very  pernicious  form  of  malarial 
fever  received  the  designation  of  the  locality  in  which  it  prevailed, 
and  passed  into  the  literature  under  the  name  of  "  Chickahominy 
fever."  While  malarial  diseases  were  largely  represented  in  the 
morbility  reports  during  the  war,  the  most  serious  results  of  the 
influence  of  the  malarial  poison  were  manifested  in  its  effects 
upon  patients  sick  with  other  diseases.  Thus,  typhoid  fever, 
dysentery,  or  pneumonia,  in  a  patient  saturated  with  malaria, 
was  very  much  more  serious  than  where  this  complication  was 
absent.  In  the  malarial  regions  in  the  interior  of  the  country, 
the  Mississippi  Valley,  and  the  southern  portion  of  the  Western 
Territories,  malarial  fevers  are  among  the  most  prevalent  camp 
diseases.  Greater  attention  in  locating  camps,  and  care  devoted 
to  draining  the  subsoil  and  maintaining  a  low  level  of  the  ground- 


238  TEXT-BOOK    OF   HYGIENE. 

water,  would  doubtless  result  in  improvement  in  the  sickness- 
rate  from  this  cause  in  the  army. 

Typhoid  Fever. — Typhoid  fever  is  prevalent  in  camps  and 
garrisons.  As  it  may  be  propagated  through  the  medium  of 
infected  discharges  of  typhoid  patients,  it  will  readily  be  perceived 
that  neglect  of  the  precaution  of  promptly  disinfecting  such  dis- 
charges will  almost  inevitably  result  in  spreading  the  disease, 
either  by  direct  inhalation  of  effluvia  from  the  patient  or  excreta, 
of  pollution  of  the  drinking-water,  or  by  contamination  of  the 
soil,  and  subsequently  of  the  atmosphere,  by  the  intestinal  dis- 
charges of  the  patient. 

Phthisis. — Especially  among  troops  in  barracks  phthisis  is 
a  very  fatal  disease.  Formerly  the  mortality  from  it  was  very 
heavy.  Recent  improvements  in  the  hygiene  of  military  posts 
and  greater  care  in  selecting  recruits  have  very  greatly  diminished 
the  death-rate  from  phthisis  among  soldiers.  Acute  pulmonary 
affections,  such  as  bronchitis,  pleurisy,  and  pneumonia,  are  com- 
paratively frequent  in  camps,  being  due  to  exposure. 

Typhus  Fever  and  Scurvy. — These  two  diseases  are  at  the 
present  day  comparatively  rare  as  camp  diseases.  They  break 
out,  however,  on  every  occasion  when  the  laws  of  hygiene  are 
violated  by  permitting  overcrowding,  overwork,  and  underfeeding. 
This  is  almost  certain  to  occur  during  war,  and  hence  either 
fully-developed  scurvy  or  a  scorbutic  taint  are  almost  constant 
accompaniments  of  an  army  in  the  field.  Among  the  allied  armies 
in  the  Crimea,  and  in  the  Federal  army  during  the  war,  scurvy 
and  typhus  fever  claimed  a  considerable  share  in  the  mortality. 

Purulent  Conjunctivitis. — This  affection  of  the  eyes  is  fre- 
quent among  soldiers.  It  has  even  been  supposed  to  be  peculiar 
to  soldier  life,  and  has  hence  been  termed  "  military  ophthalmia." 
It  is  contagious,  and  is  probably  most  often  spread  by  the  use 
of  basins  and  towels  in  common.  It  is  not  merely  annoying, 
but  is  a  very  grave  affection,  often  causing  perforation  of  the 
cornea  and  destruction  of  vision.  The  military  surgeon  should 
be  on  the  lookout  for  it,  and  promptly  isolate  those  infected. 


CAMP   DISEASES.  239 

Venereal  Diseases. — The  contagious  diseases  of  the  sexual 
organs  are  a  veritable  scourge  of  the  soldier's  life.  The  history 
of  these  diseases  is  intimately  interwoven  with  the  history  of 
armies,  camps,  and  wars.  The  first  wide-spread  appearance 
of  syphilis  in  the  fifteenth  century  is  coincident  with  the  siege 
of  Naples  by  the  French  army  under  Charles  VIII.1  It  has 
since  that  time  been  a  constant  companion  of  the  soldier  in  peace 
or  war,  and  in  all  seasons  and  countries.  Some  progress  toward 
its  restriction  has,  however,  been  made  in  recent  years  in  certain 
localities,  but  there  is  still  wide  room  for  improvement. 

In  1867  the  venereal  diseases  reported  in  the  Prussian  army 
were  53.9  per  1000  of  mean  strength.  In  1882  this  number 
had  been  reduced  to  41  per  1000,  in  1863  to  36.4,  and  in  1884 
to  32.8  per  1000.  In  the  Austrian  army  there  were  81  per 
1000  in  1870,  diminishing  to  73.5  per  1000  in  1884.  In  the 
British  army  the  ravages  of  the  venereal  diseases  were  so  terrible 
that  legal  measures  for  their  restriction  by  subjecting  prostitutes 
to  inspection  were  taken.  In  1859  the  proportion  of  venereal 
disease  among  the  home  troops  was  400  per  1000.  In  1864 
and  1866  the  passage  and  enforcement  of  the  "Contagious  Dis- 
eases Act  "  caused  a  marked  diminution  of  these  diseases.  This 
reduction  is  particularly  noticeable  in  syphilis.  The  following 
table  gives  a  comparative  view  of  the  number  of  cases  of  syphilis 
per  1000  in  the  naval  service  at  ports  under  the  acts,  and  at 
ports  where  the  acts  were  not  enforced: — 

Table  XXIII. 

Ports  Under  the  Acts.  Ports  Not  Under  the  Acts. 

1860-1863  (no  restriction),     75.02  per  1000  70.50  per  1000 

1864-1865  (acts  enforced),     79.12    "       "  100.00   "        " 

1866-1870  (acts  extended),     47.19    "       "  84.74   "       " 

1871-1880,  ....     40.64    "       "  99.35   "       " 

In  the  French  army  the  proportion  of  venereal  diseases  was 
53  per  1000  from  1862  to  1866.  In  1867  the  proportion  in- 
creased to  106  per  1000.     This  increase  was  attributed  to  the 

1  See  article  on  Syphilis,  Chapter  XIX. 


210  TEXT-BOOK   OF   HYGIENE. 

infection  during  the  Mexican  campaign.  In  1879  the  propor- 
tion had  again  diminished  to  65.9  per  1000. 

In  the  United  States  Army  the  venereal  diseases  numbered 
63  per  1000  among  the  white  and  81  per  1000  among  the 
colored  troops  in  1881.  A  chart  drawn  by  Major  Charles 
Smart,  surgeon  United  States  army,1  shows  in  an  interesting 
manner  how  opportunity  for  infection  influences  the  increase  of 
venereal  disease.  At  the  breaking  out  of  the  war,  when  large 
numbers  of  men  enlisted,  the  record  shows  a  rapid  increase  of 
venereal.  When  the  armies  were  in  the  field,  and  opportunities 
for  the  pursuit  of  Venus  were  few,  the  proportion  of  venereal 
decreased.  At  the  expiration  of  the  first  triennial  period  of 
enlistment,  the  soldier  with  his  final  pay  and  thirty  days'  fur- 
lough crowded  the  cities,  and  entered  on  a  period  of  dissipation 
which  usually  sent  him  back  to  the  recruiting  officer  with  empty 
pockets  and  an  attack  of  gonorrhoea  or  syphilis.  At  this  time 
the  records  show  a  large  number  of  cases,  which  gradually 
diminished  until  the  end  of  the  war,  when  the  opportunities 
for  infection  preliminary  to  the  final  muster-out  crowded  the 
hospitals  once  more  with  venereal  cases. 

The  experience  with  the  Contagious  Diseases  Act  in  Eng- 
land points  out  the  true  way  to  limit  or  entirely  extirpate  this 
disease  among  the  military  and  naval  forces.  An  inspection  at 
regular  intervals  not  only  of  public  prostitutes,  but  also  of  the 
soldiers  themselves,  and  segregation  of  the  infected  in  hospitals 
until  the  infective  period  is  past,  will  do  more  to  limit  the 
spread  of  venereal  disease  than  all  other  preventive  measures, 
public  or  private,  put  together. 

VI. — CIVILIAN   CAMPS. 

The  camps  of  civil  life,  whether  established,  for  the  purpose 
of  furnishing  a  refuge  to  the  inhabitants  of  cities  invaded  by 
epidemic  diseases,  as  yellow  fever  or  cholera,  or  whether  for 
religious  purposes  (camp-meetings),  or  for  recreation  (hunting 

1  Medical  and  Surgical  History  of  the  War,  third  medical  volume. 


CIVILIAN    CAMPS.  241 

and  fishing  camps,  etc.),  should  be  organized  and  managed  on  the 
same  principles  as  the  military  camp.  The  site  should  be  selected 
with  judgment — a  clean,  dry  soil,  and  abundance  of  wood  and 
water  being  requisite  for  a  healthy  camp.  A  superintendent 
or  officer  of  the  day  should  be  appointed,  whose  duty  it  is  to 
carefully  inspect  the  camp  daily,  and  compel  the  prompt  removal 
of  all  filth  and  offal  from  the  immediate  vicinity.  Cleanliness 
of  person,  clothing,  and  household  is  as  important  while 
"  roughing  it "  in  camp  as  at  home.  Singularly,  this  is  very 
often  forgotten  by  very  intelligent  people. 

The  advantage  of  a  well-administered  refugee  camp  in  case 
of  yellow-fever  epidemics  has  been  clearly  shown  by  the  brilliant 
success  of  the  depopulation  of  Memphis  during  the  epidemic  of 
1879  and  of  various  Florida  cities  and  towns  in  1888.  These 
experiments  deserve  imitation. 

[The  following  works  on  Military  and  Camp  Hygiene 
should  be  studied  in  connection  with  this  chapter : — 

Smart,  The  Hygiene  of  Camps,  in  Buck's  Hygiene  and  Public 
Health,  vol.  ii. — Wolzendorff,  Armee  Krankheiten,  in  Realeneyclopsedie 
d.  ges.  Heilk.,  Bel.  I,  p.  489. — Schuster,  Kasernen,  in  von  Pettenkofer 
und  Ziemssen's  Handbuch  der  Hygiene,  II  Th.,  2  Abth. — Cameron: 
Camps,  Depopulation  of  Memphis,  Epidemics  of  1818  and  1879.  Public 
Health,  vol.  v,  p.  152. — Frolich,  Militiirmedicin. — Medical  and  Surgical 
History  of  the  War,  especially  the  second  and  third  medical  volumes. 
— Annual  Reports  of  the  Supervising  Surgeon-General  of  the  United 
States  Marine  Hospital  Service,  1888-9.] 


16 


CHAPTER  XI. 

Marine  Hygiene. 

The  melancholy  accounts  of  the  mortality  from  scurvy, 
dysentery,  and  typhus  fever,  which  were  formerly  a  part  of  the 
history  of  so  many  naval  and  passenger  vessels,  are  happily 
now  only  records  of  the  past.  Occasionally,  however,  careless- 
ness of  the  authorities,  or  of  those  responsible  for  the  safety  of 
people  who  "  go  down  to  the  sea  in  ships,"  results  in  an  out- 
break of  one  or  other  of  these  diseases  even  at  the  present  day. 
Thus,  for  the  fiscal  year  ending  June  30,  1882,  71  cases  of 
scurvy  and  purpura  were  reported  by  the  medical  officers  of 
the  Marine  Hospital  Service.  It  appears  that  only  in  one 
instance  (where  6  cases  of  scurvy  had  occurred  on  one  vessel) 
was  any  investigation  ordered.  A  most  superficial  investigation 
showed  that  the  law  relating  to  the  issue  of  lime-juice  had  been 
violated  by  the  master  of  the  vessel.  No  prosecution  resulted. 
Such  facts  indicate  that  laxness  in  the  enforcement  of  the  regu- 
lations expressly  made  to  prevent  this  fatal  disease  may  be  again 
followed  by  outbreaks  of  greater  or  less  gravity. 

I. THE    SAILOR    AND    HIS   HABITS. 

Although  the  sailor  of  the  present  day,  especially  in  the 
naval  service,  is  morally  and  intellectually  far  in  advance  of  the 
"  Jack  Tar  "  of  former  days,  his  life,  both  afloat  and  on  shore, 
leaves  much  to  be  desired  on  the  score  of  temperance,  chastity, 
and  purity  of  thought  and  speech.  The  life  of  a  sailor  in  the 
United  States  navy,  only  thirty  years  ago,  is  thus  graphically 
described  by  Medical  Director  Albert  L.  Gihon1 :  "  She  was 
manned  by  a  motley  crew,  of  whom  Americans  were  a  minority, 

1  Thirty  Years  of  Sanitary  Progress  in  the  Navy :  Annual  address  by  the  President  to 
the  Naval  Medical  Society,  Washington,  1884. 

(243) 


244  TEXT-BOOK   OF   HYGIENE. 

and  Englishmen,  Irishmen,  Northmen,  and  '  Dagos  '  constituted 
the  far  greater  part.  Some  had  just  returned  from  another  cruise, 
having  squandered  or  been  robbed  of  their  three  years'  pay  by 
the  landsharks,  who  cajoled  them,  only  half  sober,  to  the  rendez- 
vous, to  be  reshipped,  and  thence  to  be  herded,  uncared  for,  on 
the  receiving-ship,  still  popularly  termed  the  'guardo,'  until 
drafted  on  board  the  first  sea-going  vessel.  All  of  them  were  in 
debt,  most  of  them  insufficiently  clad,  and  unable  to  properly 
outfit  themselves.  The  wretched  herd,  who  were  thus  gathered 
from  the  purlieus  of  Water  Street,  and  North  Street,  and  South 
Street,  who  at  night  were  kenneled  worse  than  dogs,  by  day 
fed  like  them — crouching  on  their  haunches  around  greasy 
mess-cloths,  cutting  with  jack-knives  or  pulling  to  pieces  with 
grimy  fingers  the  chunks  of  '  salt  horse '  and  '  duff '  which 
made  their  daily  fare,  and  which  later  in  the  cruise  were  both 
spoiled  and  scanty,  did  not  constitute  an  elevating  subject  for 
contemplation. 

"  Stint  of  good  food,"  continues  Dr.  Gihon,  "  was,  how- 
ever, not  the  chief  of  the  old-time  shell-back's  ocean  trials.  Fed 
like  a  brute,  housed  worse  than  one,  however  faithfully  his  labors 
were  performed,  there  was  for  him  only  a  long,  dreary  season 
of  imprisonment.  For  him  there  was  no  glad  holiday  on  shore, 
when  the  land  broke  the  monotony  of  the  waste  of  waters. 
The  officers  might  rush  pell-mell  out  of  the  ship,  but  Jack  could 
only  strain  his  longing  eyes  upon  the  green  fields  or  busy  sea- 
ports. Notwithstanding  the  hardships  of  the  voyage,  the 
wretched  food,  and  the  outbreaks  of  disease,  the  crew  were  con- 
fined eight  months  on  board  ship,  before  '  general  liberty '  was 
given,  and  then  men  and  boys  were  sent  on  shore  for  forty-eight 
hours  to  indulge  in  a  mad  revel,  and  to  return  crazed  by  rum, 
battered,  and  bruised.  The  poor  wretch,  first  made  ravenously 
hungry  for  dissipation  by  his  enforced  confinement,  was  then 
expected  to  be  temperate  in  the  feast  of  indulgence  offered  him, 
and  punished  with  vindictiveness  if  he  sought  to  gorge  himself 
with   the   poor  semblance  of  pleasure.     The  '  cat '  had  been 


THE   SAILOR   AND   HIS   HABITS.  245 

abolished,  but  half  a  dozen  boys  strung  upon  the  poop  'bucked 
and  gagged ' ;  half  a  dozen  men  triced  up  by  their  thumbs  in 
the  rigging ;  each  of  the  upright  coffin-like  '  sweat-boxes'  with 
its  semi-asphyxiated  inmate ;  the  '  brig '  with  its  bruised  and 
bloated  crew  in  irons ;  the  main-hold  with  its  contingent  under 
hatches ;  the  sick-list  swollen  out  of  all  proportions  by  in- 
ebriates, injured  men,  and  venereal  cases ; — these  were  the  fruits 
of  the  general  liberty,  which,  within  my  professional  life,  repre- 
sented the  sum  of  sanitary  interest  in  the  man  before  the 
mast." 

Under  such  circumstances  little  could  be  hoped  for  in  the 
way  of  personal  advancement  of  the  crew.  The  labors,  how- 
ever, of  the  writer  just  quoted,  and  others,  among  whom  may 
be  mentioned  Wilson  and  Turner,  of  the  navy,  and  Woodworth, 
Hebersmith,  and  Wyman,  of  the  Marine  Hospital  Service,  have 
drawn  prominent  attention  to  the  unsanitary  conditions  of  the 
sailor's  life,  and  legal  enactments  have  done  much  to  elevate 
him  to  his  proper  rank  as  a  human  being,  entitled  to  be  treated 
with  humanity,  at  least. 

The  seaman  in  the  navy  is  now  well  clad,  and  receives  an 
abundance  of  food,  of  good  quality,  usually  well  cooked  and 
decently  served.  "  Latrines  and  bath-  and  wash-  rooms  under 
the  top-gallant  forecastle ;  mess-tables  and  benches ;  mess- 
lockers  and  clothes-lockers ;  a  place  where,  and  opportunities 
when,  men  can  read  and  write ;  and  frequent  daily  liberty  to 
go  on  shore,  if  not  already  common  to  every  vessel,  are  yet  now 
so  generally  the  concomitants  of  the  well-officered  and  well-dis- 
ciplined and  efficient  ship,  that  ere  long  their  absence  will  be 
accounted  a  fault." x  A  medical  corps,  selected  after  the  most 
rigorous  examination  known  to  the  profession,  and  provided 
with  every  aid  and  appliance  of  medical  science,  cares  for  the 
enlisted  sailor  and  marine  when  ill  or  injured,  as  tenderly  as  for 
the  commissioned  officer. 

The  sailor  in  the  merchant  service,  however,  is  still  at  the 

1  Thirty  Years  of  Sanitary  Progress  in  the  Navy,  Gihon. 


246  TEXT-BOOK   OF   HYGIENE. 

mercy  of  inhuman  masters,  who  exact  excessive  service  in  return 
for  insufficient  food,  scanty  clothing,  miserable  lodging,  abuse, 
ill-treatment,  and  neglect  when  sick  or  disabled. 

II. THE   PASSENGER. 

During  the  ten  years  from  1870  to  1879,  inclusive,  passen- 
ger vessels  carried  1,561,126  passengers  from  foreign'  ports  en 
route  to  New  York  City.  The  mean  duration  of  each  voyage 
was  13.5  days.  Out  of  the  above  number  of  passengers  2518 
died  on  the  voyage, — a  death-rate  of  1.61  per  1000  for  the 
voyage  and  43.5  per  1000  per  annum.  These  figures  accentuate 
the  importance  of  sanitary  improvement  in  passenger  vessels. 
The  causes  of  this  excessive  mortality  among  emigrants — for  it 
is  almost  exclusively  among  the  passengers  in  the  steerage,  or 
"  between  decks,"  that  the  deaths  occur — are  overcrowding,  im- 
proper feeding,  defective  ventilation,  filthy  personal  habits,  and 
inefficient  medical  attention  when  sick.  Although  overcrowd- 
ing is  prohibited  by  statute,  yet  in  every  emigrant  vessel  that 
arrived  in  New  York  during  the  first  nine  months  of  1880  the 
number  of  passengers  was  in  excess  of  the  number  allowed  by 
law.1  The  shorter  voyages  and  better  sanitary  conditions  ob- 
tainable since  steamships,  especially  those  built  of  iron,  have 
come  into  general  use  for  the  carriage  of  passengers,  have  very 
much  reduced  the  mortality  on  ocean  voyages ;  but,  as  just 
shown,  the  death-rate  is  still  excessively  high,  and  many  more  im- 
provements in  the  hygiene  of  emigrant  vessels  and  of  passengers 
are  desirable. 

III. THE    SHIP   AS   A   HABITATION. 

As  a  habitation  for  the  sailor  and  passenger  the  ship  de- 
mands the  attention  of  the  sanitarian.  The  principal  points  in 
which  he  is  interested  are  the  construction  and  ventilation  of 
sleeping-apartments,  and  the  means  of  keeping  the  entire  ship 
clean  and  free  of  water  and  impure  air. 

The  keel  is  the  foundation  of  the  ship.     Branching  out 

1  Hygiene  in  Emigrant  Ships,  Turner,  Public  Health,  vol.  vi,  p.  24. 


THE    SHIP   AS   A   HABITATION.  247 

transversely  from  it  are  curved  timbers,  the  ribs,  which,  with  the 
keel,  constitute  the  ship's  frame.  The  ribs  are  covered  exter- 
nally and  internally  with  planking,  and  the  spaces  between  the 
two  coverings  are  the  frame-spaces,  which  are  usually  partly 
filled  with  filthy  water,  decomposing  organic  matter,  and  foul 
air.  The  water  collects  in  the  bottom  of  the  vessel,  the  bilge,1 
whence  it  is  pumped  out  of  the  vessel.  If  the  pumping  is 
neglected  the  bilge- water  becomes  very  offensive,  and  may  cause 
disease  in  persons  exposed  to  exhalations  from  it.  The  frame- 
spaces  are  rarely  ventilated,  and  hence  are  frequent  sources  of 
pollution  of  air  on  board  vessels. 

The  sleeping-apartments  of  the  crew  of  a  merchant  vessel 
are  in  the  forecastle,  usually  a  small,  dark,  damp,  filthy,  unven- 
tilated  space  in  the  bow  of  the  vessel,  where  they  are  kenneled 
like  brutes.  On  naval  vessels  the  crews  sleep  on  the  berth- 
deck,  which,  in  the  rarest  instances,  is  properly  lighted  and 
ventilated.  The  berth-deck  is  usually  below  the  water-line. 
In  nearly  all  and  even  the  best  class  of  vessels  in  the  United 
States  navy  the  air-allowance  for  each  man  is  less  than  3  cubic 
metres,  rarely  reaches  4,  is  oftener  from  2  to  2J,  and  is  some- 
times as  low  as  1  cubic  metre.  The  men  swing  by  night  in 
hammocks  suspended  from  the  beams  overhead,  and  removed 
when  not  in  use,  carried  on  deck,  and  stored  in  lockers,  called 
"hammock-nettings,"  on  the  ship's  sides. 

That  a  ship  should,  above  all,  be  seaworthy  would  seem  to 
require  no  argument.  It  is  self-evident  that  a  leaky  or  rotten 
ship  is  at  all  times  a  highly  dangerous  habitation,  yet  crews  and 
passengers  are  almost  daily  exposed  to  the  perils  of  shipwreck 
in  unsea worthy  vessels,  especially  in  the  mercantile  marine. 2 

"  Dampness,  dirt,  foul  air,  and  darkness,"  according  to 
Gihon,  "  are  the  direst  enemies  with  which  the  sailor  has  to 
battle  when  afloat."3     The  first  requisite  for  a  healthy  ship  is 

1  Hence  called  "  bilge-water." 

-  The  Safety  of  Ships  and  Those  who  Travel  in  Them,  Woodworth,  Public  Health, 
vol.  iii,  p.  79  et  seq. 

1  Naval  Hygiene,  3d  ed.,-p.  28. 


248  TEXT-BOOK   OF   HYGIENE. 

dryness.  "A  damp  ship  is  an  unhealthy  ship,"  says  Fonssa- 
grives,  the  greatest  authority  on  naval  hygiene.  From  official 
reports  it  appears  that  the  relative  humidity  of  the  berth-deck 
of  vessels  in  the  United  States  navy  is  nearly  always  above  80 
per  cent.,  very  often  rising  to  90  and  95  per  cent.1  From  the 
same  source  it  is  learned  that  the  class  of  respiratory  diseases 
furnished,  with  one  exception,  the  largest  amount  of  sickness  in 
the  navy  during  the  year  1880.  It  is  the  concurrent  testimony 
of  all  authorities  in  marine  hygiene  that  the  vicious  custom  of 
daily  drenching  the  decks  with  water,  under  the  plea  of  cleanli- 
ness, is  mainly  responsible  for  this  excessive  moisture  and  its 
results.  The  battle  of  naval  hygiene  was  long  fought  on  this 
contested  field  of  wet  decks,  until  the  fact  became  so  patent  that 
wet  ships  were  always  unhealthy  ones.  It  is,  therefore,  one 
of  the  most  important  aims  of  marine  hygiene  to  curtail  this 
practice. 

Gihon  recommends  that  the  decks  be  painted  and  then 
coated  with  shellac,  occasionally  renewed,  to  make  them  non- 
absorbent,  and  to  wet  them  as  rarely  as  possible,  consistent  with 
cleanliness,  the  smooth  surface  of  the  shellacked  deck  being 
quickly  swabbed  over  with  hot  water  and  thoroughly  dried. 

The  ship  should  be  clean  and  well  ventilated.  Efforts  to 
keep  a  ship  clean  should  not  be  expended  upon  the  decks  only; 
the  occupied  apartments  below  the  hatches,  the  bilges  and  frame- 
spaces  should  all  receive  especial  attention  from  the  sanitary 
inspector. 

It  is  quite  frequently  necessary  to  remove  the  flooring  of 
the  vessels  in  order  to  expose  the  accumulations  of  filth,  which 
often  make  an  infected  ship  synonymous  with  a  dirty  ship.  An 
unobstructed  passage,  to  which  ready  access  can  be  had  through 
removable  covers,  should  extend  under  the  flooring  from  one 
end  of  the  vessel  to  the  other.  To  disinfect  a  dirty  ship,  steam 
forced  into  the  hold  under  pressure,  before  and  after  the  filth 
has   been    cleaned    out,    gives    the   most    satisfactory   results. 

1  Report  of  Surgeon-General  of  the  Navy,  Washington,  1880. 


THE    SHIP   AS   A   HABITATION.  249 

Fumes  of  sulphur  burned  in  the  presence  of  watery  vapor,  and 
chlorine  are  next  in  efficiency.1  Solutions  of  sulphate  of  iron 
or  chloride  of  zinc  may  be  poured  into  the  bilges  to  prevent 
decomposition. 

It  has  been  estimated2  that  a  minimum  of  15  cubic  metres 
of  air-space,  with  facilities  for  thorough  ventilation,  should  be 
allowed  to  each  person  on  board  ship.  It  is  safe  to  say  that  no 
vessel  that  floats  gives  to  her  passengers  or  crew  the  advantages 
of  such  conditions.  Ventilation  of  the  holds  and  bilges,  and  of 
the  spaces  between  the  timbers  or  ribs,  "intercostal  ventilation," 
as  Turner  calls  it,  is  especially  necessary.  Any  system  of  ven- 
tilation that  does  not  contemplate  the  removal  of  the  foul  bilge- 
air  is  unworthy  of  consideration  by  the  sanitarian.  The  venti- 
lating apparatus  which  has  been  introduced  on  board  vessels  of 
the  United  States  navy  consists  essentially  of  two  longitudinal 
mains  extending  through  the  holds  and  under  the  engines,  boil- 
ers and  coal-bunkers  the  entire  length  of  the  ship,  beginning  in 
contracted  extremities  at  bow  and  stern  and  terminating  in  a 
chamber  or  "  blower-room  "  on  the  berth-deck  just  forward  of 
the  mainmast.  In  this  room  a  Sturtevant  fan  or  blower,  2  metres 
in  diameter,  is  driven  by  an  engine  at  from  150  to  300  revolu- 
tions a  minute,  expelling  the  air  through  a  70-centimetre  funnel, 
opening  high  above  the  spar-deck.  Small  metal  pipes  connect 
these  longitudinal  mains  with  every  state-room,  store-room, 
pantry,  and  other  inclosed  apartment  on  the  berth-deck,  orlop, 
and  holds,  from  which  the  foul  air  is  aspirated  by  the  revolution 
of  the  fan. 

Fresh  air  finds  its  way  below  through  the  wind-sails, 
ventilating-shafts,  hatchways,  and  air-ports,  entering  the  apart- 
ments by  way  of  doors,  crevices,  and  other  natural  apertures. 
Similar  small  metal  pipes  also  connect  the  bilges  with  the  longi- 
tudinal mains,  and  air  is  thus  drawn  through  the  frame-spaces 
between  the  timbers,  which  terminate  below  at  the  floor  of  the 

1  Report  of  Committee  on  Disinfectants,  American  Public  Health  Association. 
4  Hygiene  of  Emigrant  Ships,  Public  Health,  vol.  vi,  p.  26. 


250  TEXT-BOOK    OF   HYGIENE. 

ship  and  open  above  on  the  spar-deck,  and  a  circulation  of  fresh 
air  is  thus  established  in  the  frame  or  "  skin  "  of  the  ship,  con- 
tributing greatly  to  its  dryness  and  to  the  preservation  of  the 
material  of  the  vessel.  The  absolutely  essential  condition  of  this 
system  of  ventilation  is  that  the  blower  shall  revolve,  but, 
unfortunately,  sanitary  interests  are  too  often  sacrificed  on  the 
pretext  that  economy  of  fuel  will  not  permit  the  operation  of  the 
fan.1 

All  parts  of  the  vessel  used  as  habitations  or  sleeping- 
apartments  should  receive  sufficient  sunlight.  At  present,  very 
few  vessels  have  the  quarters  of  the  crew  so  disposed  as  to  admit 
any  sunshine  at  all. 

In  the  fire-rooms  of  steamships,  especially  on  that  class  of 
naval  vessels  termed  monitors,  the  temperature  often  rises  so 
high  as  would  seem  to  render  continued  existence  in  it  impossi- 
ble. Gihon  states  that  the  average  temperature  in  the  fire-room 
of  the  monitor  Dictator  was  145°  F.  (63°  C),  while  Turner 
states  that  in  another  vessel  the  average  fire-room  temperature 
was  167°  F.  (75°  C.).2  The  firemen  and  coal-heavers  (stokers) 
frequently  suffer  from  heat-stroke,  and,  in  a  very  large  proportion 
of  cases,  from  heart  disease. 

Lavatories  and  bathing  facilities  should  be  jiirnished  on 
vessels  for  passengers  and  crew,  and  both  should  be  compelled 
to  keep  their  bodies  and  clothing  clean.  A  more  liberal  supply 
of  water  for  drinking,  a  more  frequent  issue  of  fresh  meat  and 
vegetables,  and  better  cooking  are  the  sanitary  considerations 
to-day  in  the  subsistence  of  the  sailor.  The  American  naval 
ration  is  superior  in  A-ariety  and  palatableness  to  that  of  any 
foreign  service,  but  skilled  cooks  are  still  a  desideratum  on 
board  men-of-war,  and  medical  officers  have  long  been  insisting 
that  schools  for  their  instruction  should  be  established  at  recruit- 
ing stations.  The  composition  and  distribution  of  the  rations  are 
given  in  the  following  table : — 

1  Hygiene  (Naval),  Hand-book  of  the  Medical  Sciences,  Gihon. 
*  Buck's  Hygiene  and  Public  Health,  vol.  ii,  p.  190. 


THE   SHIP   AS   A    HABITATION. 


251 


Table  XXIV. 

ALLOWANCE   FOR   GENERAL   DAILY   USE. 
(Either  one  of  the  following.) 


Rations  Established 
by  Law. 


Specified  by  Law. 


Substitutes  Authorized  by  Law. 


Ration  No.  1  . 


Ration  No.  2 


Ration  No.  3 


Ration  No.  4 


1  lb.  salt  pork j 

|  pint  beans  or  peas  .    .   1 

1  lb.  salt  beef  .... 
£  lb.  flour 

2  ozs.  dried  fruit     .    . 

f  lb.  preserved  meat    .    . 
£  lb.  rice     .... 

2  ozs.  butter 

1 1   oz.    desiccated  mixed 
vegetables    

|  lb.  preserved  meat  .    . 

2  ozs.  butter       

1 6  ozs. desiccated  tomatoes 


1|  lb.  fresb  meat ;  or, 
I  lb.  preserved  meat. 
Vegetables  of  equal  value  ;  or, 
£  lb.  rice. 

L|  lb.  fresh  meat ;  or, 
^  lb.  preserved  meat. 
Vegetables  of  equal  value. 

No  substitute. 

£  pint  beans  or  peas. 

No  substitute. 

6  ozs.  canned  vegetables. 

No  substitute. 
No  substitute. 
6  ozs.  canned  tomatoes. 


DAILY   ALLOWANCE. 


Rations  Established 
by  Law. 


Specified  by  Law. 


Substitutes  Authorized  by  Law. 


Ration  No.  1  . 

Ration  No.  2  . 

Ration  No.  3  . 


14  oz.  biscuit 
A  oz.  tea     .    . 


4  ozs.  sugar 


1  lb   soft  bread. 
1  lb.  flour. 
£  lb.  rice. 

(  !  2  ozs.  coffee. 
I    2  ozs.  cocoa. 

f  |  For  coffee  and  sugar,  extract  of 
coffee  combined  with  milk  and 
sugar  may  be  substituted  by  the 
Secretary  of  the  Navy,  if  not 
more  expensive. 


WEEKLY   ALLOWANCE. 


Rations  Established 
by  Law. 

Specified  by  Law. 

Substitutes  Authorized  by  Law. 

Ration  No.  1  .    . 
Ration  No.  2  .    . 
Ration  No.  3  .    . 

None. 
None. 
None. 

1  These  articles  being  out  of  the  market,  and  not  procurable,  the  nearest  possible  sub- 
stitutes are  given. 

9  One-half  pint  of  pickles  is  considered  equal  to  %  lb.,  and  is  issued  as  such. 


252  TEXT-BOOK   OF   HYGIENE. 

IV. DISEASES    ON    SHIPBOARD. 

The  diseases  most  liable  to  attack  persons  on  shipboard 
are :  Diseases  of  the  respiratory  organs,  rheumatism,  malarial 
diseases,  digestive  disorders,  scurvy,  typhus  fever,  and  skin 
diseases ;  and,  where  the  infection  has  been  conveyed  to  the 
vessel  by  other  persons  or  by  fomites :  yellow  fever,  cholera, 
small-pox,  and  venereal  diseases.  It  is  interesting  to  note  in  the 
last-published  report  of  the  Surgeon-General  of  the  Navy  that, 
among  a  total  of  8550  admissions  of  sick  and  disabled  officers 
and  men  of  the  Navy  and  Marine  Service,  nearly  90  per  centum 
were  included  in  the  following  classes,  to  wit : — 


Casualties,  .... 

.         . 

191Y 

Affections  of  the  respiratory 

tract,     . 

1149 

Venereal  diseases, 

. 

ion 

Malarial  and  other  fevers,  . 

... 

888 

Diseases  of  the  integument, 

.         . 

888 

Rheumatism, 

521 

Affections  of  the  nervous  system, 

489 

Diarrhoeal  maladies,     . 

... 

483 

The  remaining  1144  were  distributed  over  a  wide  range  of 
titles,  of  which  many,  as  adynamia,  cephalalgia,  constipation, 
odontalgia,  etc.,  have  no  special  pathological  significance.  It  is 
probable  that  only  about  one-fourth  of  the  cases  of  disease 
occurring  at  sea  are  attributable  to  any  of  the  circumstances  of 
oceanic  life,  and  these  are  almost  entirely  inflammatory  affections 
of  the  air-passages  and  intestinal  tract,  neuroses,  including 
nausea  marina,  and  rheumatism.1 

Most  of  these  affections  can  be  prevented  by  proper  meas- 
ures of  hygiene,  as  demanded  by  the  conditions  described  in  this 
chapter  or  by  the  enforcement  of  the  following  regulations : — 

Inspection  of  crews  and  passengers  should  be  made  com- 
pulsory before  shipment.  Persons  suffering  from  contagious  or 
infectious  diseases  should  not  be  taken  on  board.2     In  order  to 

1  The  Therapy  of  Ocean  Climate,  Gihon,  Transactions  of  American  Climatological  Asso- 
ciation, 1889. 

2  Gihon  relates  an  instance  where  a  man  suffering  from  parotitis  was  transferred  from 
the  hospital  of  a  receiving-ship  to  a  vessel  going  to  sea.  The  disease  was  communicated  to 
more  than  seventy  of  the  crew  of  the  latter  vessel. 


DISEASES   ON    SHIPBOARD.  253 

make  this  provision  effective,  the  history  of  the  individual  for 
two  weeks  prior  to  his  application  for  shipment  should  be  known 
to  the  inspecting  officer.  Passengers  should  possess  bills  of 
health  from  the  local  authorities  at  their  homes,  in  order  that 
the  presence  or  absence  of  such  diseases  as  small-pox,  yellow 
fever,  cholera,  or  plague  may  be  established  by  the  inspector. 
Cholera  has  always  been  introduced  into  this  country  by  immi- 
grants. Everybody  admitted  to  the  ship  should  be  vaccinated. 
During  several  years  past  a  number  of  epidemics  of  small-pox 
have  been  traced  to  foreign  immigrants  who  had  not  been 
properly  vaccinated. 

Sailors  in  the  merchant  service  should,  like  those  in  the  navy, 
be  submitted  to  a  close  personal  inspection,  and  those  suffering 
from  venereal  diseases  should  be  rejected.  The  usual  history 
of  the  cases  is  that  they  soon  go  on  the  sick-list,  and  thus 
become  an  incumbrance  instead  of  an  aid  on  the  vessel. 
Statistics  show  that  1  man  in  every  7  or  8  in  the  naval  service 
and  1  in  every  4  of  the  crews  of  merchant  vessels  are  affected 
with  some  form  of  venereal  malady.1  These  inspections  should 
not  be  restricted  to  examinations  for  venereal  diseases,  but  indi- 
viduals incapacitated  for  the  performance  of  a  seaman's  duties 
by  any  cause  should  be  rejected.  This  precaution  would  un- 
questionably reduce  the  number  of  marine  disasters  directly 
traceable  to  deficiency  in  the  working  force  on  board  vessels. 
In  this  country  the  services  of  the  medical  officers  of  the  Marine 
Hospital  Service  might  be  made  available  to  carry  out  these 
inspections. 

All  sailors  are  liable  to  be  placed  in  positions  where  the 
prompt  and  accurate  distinction  of  colors  becomes  necessary, 
hence  all  color-blind  individuals  should  be  rejected  as  seamen. 
The  inability  to  distinguish  colors  has  often  been  the  cause  of 
grave  accidents  at  sea.  Pilots  can  no  longer  obtain  a  license 
unless  they  satisfactorily  pass  an  examination  with  reference  to 
their  ability  to  distinguish  colors. 

1  The  Prevention  of  Venereal  Diseases,  Gihon,  Public  Health,  1882. 


254  TEXT-BOOK   OF   HYGIENE. 

[The  following  works  contain  more  detailed  information 
upon  the  subject  treated  in  the  foregoing  chapter: — 

A.  L.  Gihon,  Practical  Suggestions  in  Naval  Hygiene,  3d  ed., 
Washington,  18*73. — T.  J.  Turner,  Hygiene  of  the  Naval  and  Merchant 
Marine. — Buck's  Hygiene  and  Public  Health,  vol.  ii. — Walter  Wyman, 
Hygiene  of  Steamboats  on  the  Western  Rivers. — Report  of  Supervising 
Surgeon-General  M.H.  Service  for  1882. — Annual  Reports  of  the  Surgeon- 
General  of  the  Navy  for  18*79,  1880,  and  1881. — Various  papers  by  J.  M. 
Wooclworth,  A.  L.  Gihon,  T.  J.  Turner,  Hebersrnith,  and  A.  N.  Bell  in 
Public  Health,  vols,  i,  iii,  and  vi. — Hygiene,  Naval,  by  Albert  L.  Gihxm, 
M.H,  in  Reference  Hand-book  of  Med.  Sciences.] 


CHAPTER  XII. 

Prison  Hygiene. 

Although  the  frightful  mortality  which  formerly  seemed  a 
necessary  accompaniment  of  the  life  of  the  convict  has  in  the 
past  half-century  markedly  diminished,  the  death-rate  among 
prisoners  is  still  very  greatly  in  excess  of  that  of  persons  of  the 
same  age  in  a  state  of  liberty. 

The  observations  and  labors  of  John  Howard,  the  self- 
sacrificing  philanthropist,  in  the  latter  half  of  the  last  century, 
and  of  Elizabeth  Fry,  in  the  first  half  of  the  present,  directed 
the  attention  of  legislators  to  the  necessity  of  reform  in  the  con- 
duct of  prisons  and  the  treatment  of  prisoners.  As  a  conse- 
quence of  the  labors  of  these  reformers,  the  principles  of  prison 
discipline  have  been  more  fully  developed  during  the  past  forty 
years  by  students  of  social  science  everywhere,  and  certain 
propositions  have  been  formulated,  which  govern,  to  a  greater 
or  less  degree,  legislation  upon  this  subject.  These  propositions 
are,  briefly,  as  follow : — 

Prisoners  must  be  properly  classified  according  to  the 
nature  of  their  crime  and  the  duration  of  imprisonment. 

The  two  sexes  must  be  strictly  separated,  and  no  oppor- 
tunity given  for  intermingling  while  in  the  prison. 

Female  prisoners  should  have  female  attendants  exclusively. 
Male  watchmen  or  other  attendants  should  not  be  allowed  in 
the  female  department  of  a  prison. 

All  prisoners  must  be  kept  employed  at  some  manual  labor, 
not  necessarily  for  profit,  but  as  an  agency  in  the  moral  reforma- 
tion of  the  convict. 

Punishments  for  infractions  of  discipline  must  not  be 
excessive. 

(255) 


256  TEXT-BOOK   OF   HYGIENE. 

Efforts  should  be  constantly  made  tending  to  the  reclama- 
tion of  criminals  from  their  life  of  sin  and  crime. 

Due  care  must  be  taken  by  the  State  to  preserve  the  health 
and  life  of  the  prisoner  whom  the  State  has  deprived  of  liberty 
and  the  opportunity  of  taking  care  of  himself. 

A  proper  classification  of  prisoners,  according  to  the  degree 
of  their  criminality,  the  nature  of  the  crime  of  which  they  have 
been  convicted,  or  the  length  of  time  for  which  they  have  been 
sentenced,  is  now  insisted  upon  by  all  students  of  prison  dis- 
cipline. As  this  subject  more  nearly  concerns  the  social  or  legal 
relations  of  prisoners  rather  than  their  sanitary  interests,  it  is 
here  passed  over  with  a  mere  mention. 

The  separation  of  the  sexes,  necessity  of  female  attendants 
on  prisoners  of  the  same  sex,  employment  of  prisoners,  and  moral 
reformation  of  criminals  likewise  belong  especially  to  the  social 
aspects  of  the  question,  and  can  find  no  discussion  in  this  place. 

Regarding  the  remaining  proposition,  however,  that  which 
demands  that  the  State  shall  exercise  due  care  over  the  prisoner's 
health,  it  comprises  a  question  that  demands  consideration  in  a 
text-book  on  hygiene. 

There  is  now  a  general  concurrence  of  opinion  that  the 
State,  in  depriving  any  person  of  liberty,  has  no  right  to  subject 
the  individual  suffering  such  deprivation  to  any  danger  of  disease 
or  death.  In  other  words,  the  State  has  no  right  to  abbreviate 
the  life  of  the  convict  sentenced  to  prison.  This  proposition 
requires  that  the  State  see  to  it  that  the  prisoner  is  well  fed, 
well  clothed,  and  well  housed ;  that  he  shall  be  well  cared  for 
wrhen  sick,  and  that  when  his  term  of  imprisonment  expires  he 
shall  be  set  at  liberty,  with  only  such  effect  upon  his  normal 
expectation  of  life  as  would  result  from  the  ordinary  wear  and 
tear  of  life  upon  his  health. 

It  must  be  confessed,  however,  that  the  State  is  very  far 
short  of  attaining  this  object.  The  mortality  of  convicts,  even 
in  the  best-regulated  prisons,  where  especial  attention  is  paid  to 
the  sanitary  requirements  of  such  buildings,  is  three  times  as 


PRISON   HYGIENE.  257 

great  as  among  workmen  in  mines,  confessedly  one  of  the  most 
dangerous  occupations.  If  insurance  companies  desired  to 
insure  the  lives  of  prisoners,  the  companies  would  be  obliged,  in 
order  to  secure  themselves  against  loss,  to  make  the  premium 
equivalent  to  an  advance  in  age  of  twenty  years.  This  means 
that  a  free  person  has  as  long  an  expectation  of  life  at  40 
years  as  a  prisoner  has  at  20.  Attention  is  again  called  to 
the  fact  that  the  conditions  in  the  most  favorably  situated  and 
liberally  managed  prisons  only  are  here  considered.  What  the 
results  are  in  other  institutions,  less  favorably  constructed  and 
managed,  will  be  apparent  from  the  following  brief  statement : 
Mr.  George  W.  Cable  has  shown1  that  in  some  of  the  prisons 
in  the  Southern  States,  under  the  vicious  lease  system,  the 
mortality  is  eight  to  ten  times  greater  than  in  properly  con- 
structed and  managed  prisons  elsewhere.  In  Louisiana,  for 
example,  14  per  cent,  of  all  the  prisoners  died  in  1881 ;  and  in 
the  convict  wood-cutting  camps  of  the  State  of  Texas  one-half 
of  the  average  number  so  employed  during  1879  and  1880  died. 

The  mortality  of  prisoners  is  greatest  in  the  second,  third, 
and  fourth  years  of  their  confinement.  In  Millbank  Prison,  in 
England,  the  death-rate  per  1000  was  3.05  in  the  first  year, 
35.64  in  the  second,  52.26  in  the  third,  57.13  in  the  fourth,  and 
44.17  in  the  fifth  years  of  imprisonment. 

The  diseases  most  frequent  among  prisoners  are  pulmonary 
phthisis  and  diseases  of  inanition,  manifested  by  general  dropsy. 
Consumption  furnishes  from  40  to  80  per  cent,  of  all  deaths. 
When  prisoners  are  attacked  by  acute  febrile  or  epidemic  diseases 
(small-pox,  cholera,  dysentery),  the  mortality  is  much  higher 
than  among  persons  in  a  state  of  liberty.  This  fatality  is  due 
to  an  anaemic  or  cachectic  condition,  which  has  been  called  "  the 
prison  cachexia," — a  depravement  of  constitution  which  yields 
readily  to  the  invasion  of  acute  diseases. 

Prisons  should  be  built  upon  a  healthy  site,  be  properly 
heated   and  ventilated,  have  an  abundant   water-supply,  and 

1  Century  Magazine,  February,  1884. 
17 


258  TEXT-BOOK   OF   HYGIENE. 

be  supplied  with  facilities  for  a  prompt  and  thorough  removal 
of  sewage.  Baths  and  lavatories  should  be  conveniently  ar- 
ranged in  order  that  thorough  cleanliness  can  be  enforced. 

The  problem  of  feeding  prisoners  requires  careful  study. 
The  food  should  not  only  be  sufficient  in  quantity  and  of  good 
quality,  but  it  should  be  well  cooked,  and  the  bill  of  fare  varied 
often  in  order  to  avoid  creating  a  disgust  by  an  everlasting 
sameness.  Prisoners  often  suffer  from  nausea  and  other  digestive 
derangements,  brought  on  solely  by  the  monotonous  character 
of  the  daily  food. 

In  workshops  and  sleeping-rooms,  dormitories  or  cells,  the 
cubic  air-space  allowed  to  each  inmate  should  not  be  less  than 
17  cubic  metres,  with  proper  provision  for  ventilation.  The 
use  of  dark  or  damp  cells  as  places  of  confinement  is  a  relic  of 
the  barbarism  in  the  treatment  of  convicts  against  which  John 
Howard  raised  his  voice  so  effectively  in  the  last  century.  An 
abundance  of  sunlight  should  be  admitted  into  every  room  in 
which  a  human  being  is  confined. 

An  important  hygienic  measure  is  daily  exercise  in  the 
open  air.  It  should  be  regularly  enforced,  and  its  modes 
frequently  varied  in  order  that  it  may  not  degenerate  into  a 
mere  perfunctory  performance. 

Punishment  for  infractions  of  the  prison  discipline  should 
be  inflicted  without  manifestation  of  passion,  and  only  under  the 
immediate  direction  of  some  official  responsible  to  the  State. 
It  is  questionable  whether  physical  punishments,  such  as 
whipping,  tricing  up  by  the  thumbs  with  the  toes  just  touching 
the  floor,  bucking  and  gagging,  and  similar  barbarities  should 
be  permitted  under  any  condition.  The  permission  to  exercise 
such  power  is  extremely  liable  to  be  abused  by  officials.  The 
system  of  leasing  out  prisoners  to  private  parties,  which  prevails 
in  some  of  the  southern  United  States  is  vicious  in  the  extreme, 
because  it  places  the  convict  under  the  control  of  persons  not 
responsible  to  the  State,  and,  in  the  majority  of  instances,  morally 
unfitted  to  wield  the  power  of  inflicting  punishment. 


PRISON    HYGIENE.  259 

[The  following  works  on  prison  hygiene  and  prison  reform 
are  recommended  to  the  student : — 

A.  Baer,  Gefangniss-Hygiene,  in  von  Pettenkofer  unci  Ziemssen's 
Handbuch  der  Hygiene,  II  TIi.,  2  Abth. — Trans.  International  Peniten- 
tiary Congress,  London,  1882. — Trans.  National  Prison  Association, 
Baltimore,  1812. — G-.  W.  Cable,  The  Convict-Lease  System  in  the  South- 
ern States,  Century  Magazine.  February   1884.] 


CHAPTER  XIII. 

Exercise  and  Training. 

The  healthy  functions  of  the  bodily  organs  can  only  be 
maintained  by  more  or  less  constant  use.  A  muscle  or  other 
organ  that  is  unused  soon  wastes  away,  or  becomes  valueless  to 
its  possessor.  On  the  other  hand,  trained  use  of  the  various 
organs  makes  them  more  effective  for  the  performance  of  their 
functions.  Thus,  by  practice,  the  eye  can  be  trained  to  sharper 
vision,  the  ear  to  distinguish  slight  shades  of  sound,  the  voice  to 
express  varying  emotions,  the  tactile  sense  to  accurately  appre- 
ciate the  most  minute  variations  of  surface  and  temperature,  and 
the  hand  to  greater  steadiness  or  the  performance  of  difficult 
and  complex  feats.  The  effectiveness  of  other  organs,  muscles, 
or  groups  of  muscles  can  also  be  increased  by  systematic  train- 
ing, as  is  seen  in  the  athlete  and  gymnast. 

PHYSIOLOGICAL   EFFECTS   OF  EXERCISE. 

When  a  muscle  contracts,  the  now  of  blood  through  it  is 
increased.  Hence,  contraction  of  a  muscle,  which  consumes  or 
converts  stored-up  energy,  at  the  same  time  draws  upon  the  cir- 
culation for  a  new  supply  of  food-material  to  replace  that  con- 
sumed. The  activity  of  the  circulation  through  a  muscle  in 
action  results  in  increased  nutrition  and  growth  of  the  muscle. 

During  muscular  action  the  activity  of  the  respiratory 
process  is  increased.  A  larger  quantity  of  air  is  taken  into  the 
lungs,  more  oxygen  is  absorbed  by  the  blood,  and  an  increased 
elimination  of  carbon  dioxide  takes  place.  The  experiments  of 
Pettenkofer  and  Voit  show  that,  while  in  a  state  of  rest  the 
average  absorption  of  oxygen  in  twelve  hours  amounted  to  708.9 
grammes,  during  work   the  amount  reached    954.5   grammes. 

(261) 


262  TEXT-BOOK   OF   HYGIENE. 

For  the  same  period  the  elimination  of  carbonic  dioxide  was: 
during  rest,  911.5  grammes;  during  work,  1284.2  grammes. 

Upon  the  circulation  muscular  exercise  likewise  exerts  a 
manifest  influence.  The  action  of  the  heart  is  increased  both  in 
force  and  frequency,  the  arteries  dilate,  and  the  blood  is  sent 
coursing  through  the  system  more  rapidly  than  when  the  body 
is  at  rest. 

Cutaneous  transpiration  is  also  promoted  by  muscular  exer- 
cise. It  is  probable  that  in  this  way  some  of  the  effete  matters 
in  the  system  are  removed,  being  held  in  solution  and  carried 
through  the  skin  in  the  perspiration. 

PHYSICAL    TRAINING. 

There  can  be  no  question  that  systematic  training  of  the 
muscles  has  a  favorable  influence  upon  health  and  longevity. 
Persons  who  are  actively  engaged  in  physical  labor,  other  things 
being  equal,  are  healthier,  happier,  and  live  longer  than  those 
whose  occupation  makes  slight  demands  upon  their  muscular  sys- 
tem. In  default  of  an  active  occupation  the  latter  class  is  forced,  if 
good  health  is  desired,  to  adopt  some  form  of  exercise  which 
will  call  the  muscles  into  activity. 

The  principal  methods  of  physical  training  are  walking  or 
running,  rowing,  swimming,  and  the  various  in-door  gymnastic 
exercises.  Rapid  walking  or  running  is  one  of  the  best  methods 
of  physical  exercise,  for,  not  only  are  the  muscles  of  the  legs  and 
thighs  developed,  but  the  capacity  of  the  chest  is  increased — one 
of  the  principal  objects  of  physical  training.  By  combining 
walking  with  some  form  of  in-door  gymnastics,  such  as  practice 
with  dumb-bells,  Indian  clubs,  rowing-machines,  or  pulley- 
weights,  nearly  all  the  good  effects  of  the  most  elaborate  system 
of  training  can  be  obtained. 

For  the  gymnastic  exercises  various  forms  of  useful  labor 
may  be  substituted  with  advantage,  such  as  wood-chopping  or 
sawing,  or  moderate  work  at  any  physical  labor. 

The  scheme  of  studies  in  our  public-school  system  should 


PHYSICAL   TRAINING.  263 

include  physical  training  for  both  sexes.  This  is  a  question  not 
merely  of  individual,  but  of  national  importance.  Weak  and 
unhealthy  children  are  not  likely  to  grow  up  into  strong  and 
healthy  men  and  women;  and  the  latter  are  necessary  for  the 
perpetuity  of  the  nation.  The  time  seems  to  have  arrived  when 
physical  education  should  no  longer  be  looked  upon  as  a  whim 
of  unpractical  enthusiasts  and  hobby-riders,  but  as  an  indispen- 
sable element  in  every  school  curriculum. 

There  is  a  tendency  among  instructors  in  physical  training 
to  make  their  systems  too  complicated,  or  dependent  upon  expen- 
sive or  cumbersome  apparatus.  This  is  to  be  deprecated.  All 
the  muscles  of  the  body  can  be  called  into  action  by  very  simple 
exercises,  easily  learned  and  readily  carried  out. 

An  important  preliminary  to  all  methods  of  training  is  a 
thorough  physical  examination  of  the  pupil  by  a  competent 
physician,  in  order  to  determine  whether  certain  exercises  are 
allowable.  For  example,  in  all  organic  heart  affections  exer- 
cises of  a  violent  character  must  be  interdicted.  A  boy  or  man 
with  valvular  disease  of  the  heart  cannot  run,  row,  or  swim 
with  safety.  The  organ  is  easily  overtasked  in  this  condition 
and  liable  to  fail  in  its  function. 

One  of  the  simplest  and  best  methods  to  cause  the  pupil  to 
assume  a  correct  position  of  the  body,  and  to  acquire  ease  and 
grace  in  his  movements,  is  to  teach  him  the  "setting-up,"  as 
practiced  in  the  United  States  army.1 

In  walking,  a  free,  swinging  step  should  be  acquired,  with 
the  head  erect,  shoulders  thrown  back,  and  chest  well  to  the 
front,  the  whole  body  from  the  hips  upward  inclining  slightly 
forward.  The  clothing  should  be  loose  around  the  upper  part 
of  the  body,  in  order  not  to  interfere  with  the  freest  expansion 
of  the  chest,  and  to  give  the  lungs  and  heart. ample  room  for 
movement.  Even  in-door  gymnastic  exercises  alone,  when  prac- 
ticed under  intelligent  provision,  will  accomplish  very  favorable 
results,  as  shown  by  the  following  table: — 

1  Upton's  Infantry  Tactics.    School  of  the  Soldier,  Lesson  I. 


264 


TEXT-BOOK   OF   HYGIENE. 


Table  XXY. 

Showing  Average  State  of  Development  on  Admission  to  Gymnasium  ;  Average  State 
of  Growth  and  Development  after  Six  Months'  Practicing  Two  Hours  a  Week, 
and  Average  Increase  During  that  Time.  (Bowdoin  College  Gymnasium,  under 
Dr.  D.  A.  Sargent.  Two  Hundred  Students  from  the  Classes  of  1873  to  1877, 
inclusive.     Average  Age,  18.3  Years.)1 


On  Admission. 


After  Six 
Months' 
Practice. 


Average 
Increase. 


Height 

Weight 

Chest  (inflated)    . 
Chest  (contracted) 
Forearm  .  .    . 

Upper  arm  (flexed) 
Shoulders  (width) 

Hips 

Thigh 

Calf 


170. 
60. 
87 
80. 
25. 
27. 
38 
78 
48 
31 


cm. 
7  kg. 

5  cm. 

6  " 

5  " 

7  " 
7  " 
7  " 
2  " 


170  6  cm. 
61.6  kg. 

91.8  cm. 

82.4 

26.8 

29 

40.5 

84.4 

52.6 

33. 


.6  cm. 
900.    gms. 
4.3  cm. 
1.8   " 
1.8    " 
15    " 

1.8  " 

5.7  " 

3.9  " 

1.8  " 


OVEREXERTION. 

However  necessary  for  the  preservation  of  health  physical 
exercise  may  be,  overexertion  should  be  carefully  avoided. 
Overstrain  and  hypertrophy  of  the  heart  are  often  the  results  of 
excessive  exertion.  Dr.  Da  Costa  has  described  a  form  of  "  irri- 
table "  and  weak  heart  occurring  especially  among  soldiers,  which 
he  has  clearly  traced  to  overexertion.  Severe  labor  and  violent 
athletic  exercises  have  been  followed  by  like  serious  results. 
Long-distance  pedestrianism  has  furnished  within  recent  years 
quite  a  number  of  individuals  who  were  broken  down  in  health 
by  the  excessive  strain  on  the  physical  organization  involved. 
Cardiac  strain  is  not  infrequent  among  this  class. 

Spasm,  paralysis,  or  atrophy  of  muscles  sometimes  results, 
when  these  are  exhausted  by  uninterrupted  or  excessive  exer- 
cise. This  effect  is  shown  by  writers'  and  telegraphers'  cramp, 
and  similar  affections.  For  these  reasons  it  is  important  that 
both  exercise  for  health  and  actual  work  should  be  so  regulated 
as  to  conduce  to  the  individual's  benefit,  and  not  to  his  detri- 
ment. 


1  Apparatus  used :  Weights,  4500  to  6750  grammes ;  Dumb-bells,  1125  grammes ;  Indian 
clubs,  1575  grammes  ;  Pulleys. 


OVEREXERTION.  265 

[On  the  subjects  embraced  in  this  chapter  the  following 
works  may  be  studied  with  advantage : — 

A  Braynton  Ball,  Physical  Exercise,  in  Buck's  Hygiene  and  Public 
Health,  vol.  i. — Wm.  Blaikie,How  to  Get  Strong  and  How  to  Stay  So. — 
A.  Maclaren,  Training  in  Theory  and  Practice.] 


CHAPTER  XIV. 

Baths  and  Bathing. 

The  most  important  sanitary  object  of  bathing  is  cleanli- 
ness. A  secondary  object  of  the  bath  is  to  stimulate  the  func- 
tions of  the  skin,  and  to  produce  a  general  feeling  of  exhilaration 
of  the  body.  Baths  are  used  of  various  temperatures.  A  cold 
bath  has  a  temperature  of  from  4°  to  24°  C.  (40°  to  75°  F.) ;  a 
tepid  bath  from  24°  to  30°  C.  (75°  to  85°  F.),  a  warm  bath  from 
30°  to  38°  C.  (85°  to  100°  F.),  and  a  hot  bath  from  38°  to  43° 
C.  (100°  to  110°  R). 

Tepid.,  warm,  or  hot  baths  are  used  principally  as  cleansing 
agents  or  as  therapeutic  measures.  They  cause  dilatation  of 
the  cutaneous  capillaries,  diminish  blood-pressure,  and  reduce 
nervous  excitability.  The  hot  bath  is  also  a  method  for  restor- 
ing warmth  to  the  body  in  certain  cases  of  shock,  or  to  remove 
the  immediate  effects  of  injurious  exposure  to  low  temperature. 

The  so-called  Russian  and  Turkish  baths,  so  popular  in  the 
larger  cities  of  this  country,  are  modifications  of  vapor-  and  hot- 
air  baths,  or  rather  combinations  of  these  with  cold  baths.  The 
Turkish  bath  is  especially  to  be  recommended  for  its  depurative 
and  invigorating  effects. 

Cold  baths  are  used  not  merely  for  their  cleansing  effects, 
but  principally  for  their  stimulating  effects  upon  the  system. 
When  first  plunging  into  a  cold  bath  there  is  usually  a  moment- 
ary shock;  the  respiration  is  gasping,  and  the  pulse  is  increased 
in  frequency.  These  symptoms  disappear  in  a  few  moments, 
however,  and  reaction  follows.  To  a  healthy  person  a  cold  bath 
is  a  delightful  general  stimulant,  removing  the  sense  of  fatigue 
after  physical  exertion  and  causing  an  extremely  refreshing 
sensation  throughout  the  body. 

(267) 


268  TEXT-BOOK   OF   HYGIENE. 

As  a  therapeutic  measure,  the  cold  bath  has  a  wide  field 
of  usefulness.  For  the  reduction  of  the  bodily  temperature  in 
fevers  and  inflammatory  diseases,  and  especially  in  heat-stroke, 
it  is  more  prompt  and  effective  than  any  other  agent  at  the  com- 
mand of  the  physician. 

Sea-Bathing . — The  most  stimulating  form  of  the  cold  bath 
is  doubtless  the  salt-water  bath  as  taken  at  the  sea-shore.  The 
revulsive  effect  of  the  impact  of  the  waves  and  breakers  upon 
the  skin  and  the  stimulation  due  to  the  saline  constituents  of 
the  sea- water  heighten  the  invigorating  effects  of  the  simple  cold 
bath.  The  beneficial  results  of  sea-bathing  are,  however,  not 
entirely  due  to  the  bath,  but  are  to  a  great  degree  dependent 
upon  the  bracing  air  of  the  sea-shore,  absence  of  the  care  and 
anxieties  of  business,  and  the  temporary  change  in  food  and 
habits  that  a  residence  at  the  sea-side  involves.  Nevertheless, 
salt-water  baths  are  more  stimulant  to  the  skin  than  those  of 
simple  water,  and  part  of  the  good  effects  of  sea-bathing  can 
often  be  obtained  from  a  salt-water  bath  taken  at  home.  The 
following  mixture  of  salts  dissolved  in  about  125  litres  of  water 
for  one  bath  makes  a  fairly  good  substitute  for  a  sea-bath : — 

Take  of  Chloride  of  sodium  (common  salt),     .         .        .4  kilogrammes. 
Sulphate  of  sodium  (Glauber's  salt),  .        .        .     2  " 

Chloride  of  calcium, £  kilogramme. 

Chloride  of  magnesium 1£  kilogrammes. 

There  is  a  prevalent  popular  belief  that  it  is  extremely  dan- 
gerous to  enter  a  cold  bath  when  heated  or  perspiring.  The 
author  is  of  the  opinion  that  this  belief  is  erroneous.  The  stim- 
ulant and  bracing  effects  of  the  cold  bath  are  most  manifest  if  it 
be  taken  while  the  individual  is  very  warm  or  bathed  in  perspira- 
tion. Several  years  ago  the  author  made  a  series  of  observations 
upon  himself  to  determine  the  effects  of  the  cold  bath  when 
the  body  was  very  warm.  Every  afternoon  a  free  perspiration 
was  provoked  by  a  brisk  walk  of  about  2  kilometres  in  the  sun. 
As  soon  as  the  clothing  could  be  cast  off,  and  while  the  body 
was  still  freely  perspiring,  a  plunge  was  taken  into  a  fresh-water 
bath  of  about  15.5°  C.  (60°  F.).-   No  ill  results  followed;    on 


RULES   FOR   BATHING.  269 

the  contrary,  the  sensation  immediately  following  the  bath,  and 
for  six  or  eight  hours  afterward,  was  exceedingly  pleasant.  The 
health  remained  perfect,  and  the  weight  decidedly  increased 
during  the  two  months  the  practice  was  continued.  There  is 
probably  no  danger  to  a  healthy  person  in  this  practice,  but  it  is 
considered  advisable  to  immerse  the  head  first  ("  take  a  header  "), 
to  avoid  increasing  the  blood-pressure  in  the  brain  too  greatly, 
which  might  result  if  the  body  were  gradually  immersed  from 
the  feet  upward. 

RULES   FOR   BATHING. 

The  following  series  of  rules  have  been  issued  by  the 
English  Royal  Humane  Society,  and  are  all  worth  observing  by 
bathers:  "Avoid  bathing  within  two  hours  after  a  meal.  Avoid 
bathing  when  exhausted  by  fatigue  or  from  any  other  cause. 
Avoid  bathing  when  the  body  is  cooling  after  perspiration. 
Avoid  bathing  altogether  in  the  open  air,  if,  after  having  been 
a  short  time  in  the  water,  there  is  a  sense  of  chilliness,  with 
numbness  of  the  hands  and  feet;  but  bathe  when  the  body  is 
warm,  provided  no  time  is  lost  in  getting  into  the  water.  Avoid 
chilling  the  body  by  sitting  or  standing  undressed  on  the  banks 
or  in  boats,  after  having  been  in  the  water.  Avoid  remaining 
too  long  in  the  water,  but  leave  the  water  immediately  if  there 
is  the  slightest  feeling  of  chilliness.  The  vigorous  and  strong 
may  bathe  early  in  the  morning  on  an  empty  stomach.  The 
young,  and  those  who  are  weak,  had  better  bathe  two  or  three 
hours  after  a  meal ;  the  best  time  for  such  is  from  two  to  three 
hours  after  breakfast.  Those  who  are  subject  to  giddiness  or 
faintness,  or  suffer  from  palpitation  or  other  sense  of  discomfort 
at  the  heart,  should  not  bathe  without  first  consulting  their 
medical  adviser." 

To  these  instructions  may  properly  be  added  that  a  warm 
or  hot  bath  should  be  avoided,  if  the  person  is  liable  to  ex- 
posure to  cold  within  a  few  hours  after  the  bath;  that  women 
should,  as  a  rule,  not  take  a  cold  bath  while  menstruating,  or 
during  the  last  two  months  of  pregnancy;    and  that  persons 


270  TEXT-BOOK   OF   HYGIENE. 

suffering  from  organic  heart  disease  should  especially  avoid  surf- 
bathing. 

After  bathing  the  body  should  be  thoroughly  dried  with 
soft  towels,  otherwise  eczematous  eruptions  are  liable  to  follow 
in  the  parts  subject  to  friction  from  opposing  surfaces  of  the 
skin,  as  in  the  groins,  the  perinseum  and  inner  surface  of  the 
thighs,  the  armpits,  or  the  under  surface  of  the  breasts  in 
women  in  whom  these  organs  are  large  and  pendant. 

Friction  of  the  skin  with  a  coarse  towel,  or  so-called 
"  flesh-brush,"  is  a  popular  practice,  but  is  not  to  be  universally 
commended.  The  hypersemia  of  the  surface  thus  produced 
may  sometimes  induce  cutaneous  diseases  (erythema,  eczema, 
psoriasis)  in  those  predisposed. 

DANGERS    OF    COLD   BATHING. 

One  of  the  most  serious  dangers  of  cold  bathing,  but  which 
is  not  sufficiently  appreciated,  is  the  tendency  to  nausea  and 
vomiting  if  the  stomach  contains  much  food.  There  can  be  no 
doubt  that  many  of  the  cases  that  are  called  "  cramp,"  and  which 
frequently  result  in  drowning,  are  due  to  this  cause.1 

Cramps  of  the  various  muscles  sometimes  occur,  rendering 
the  bather  helpless,  and  if  in  deep  water  he  is  liable  to  drown 
before  assistance  can  reach  him. 

HOW   TO   RESTORE   THE    APPARENTLY   DROWNED. 

In  drowning  death  takes  place  by  asphyxia.  The  respira- 
tion is  arrested  by  the  submersion  of  the  head,  the  carbonized 
blood  gradually  poisons  the  system,  and  the  heart  ceases  to  beat. 
So  long  as  the  heart  will  react  to  its  appropriate  stimulus  the 
person  may  be  restored  to  life.  The  first  thing  to  do,  therefore, 
after  a  recently-drowned  person  is  taken  out  of  the  water,  is  to 
attempt  to  re-establish  the  arrested  respiration.  Several  methods 
are  in  use  for  this  purpose.  Sylvester's  is  one  of  the  simplest. 
It  is  as  follows  : — 

1  So  far  as  the  author  is  aware,  Dr.  John  Morris,  of  Baltimore,  first  called  especial  atten- 
tion to  this  source  of  danger. 


HOW   TO    RESTORE   THE    APPARENTLY    DROWNED.  271 

The  body  being  placed  on  the  back  (either  on  a  flat  sur- 
face or,  better,  on  a  plane  inclined  a  little  from  the  feet  upward), 
a  firm  cushion  or  similar  support  (a  coat  rolled  up  will  answer) 
should  be  placed  under  the  shoulders,  the  head  being  kept  in  a 
line  with  the  trunk.  The  tongue  should  be  drawn  forward  to 
raise  the  epiglottis  and  uncover  the  windpipe.  The  arms  should 
be  grasped  just  above  the  elbows  and  drawn  upward  until  they 
nearly  meet  above  the  head,  and  then  at  once  lowered  and  re- 
placed at  the  side.  This  should  be  immediately  followed  by 
pressure  with  both  hands  upon  the  belly,  just  below  the  breast- 
bone. The  process  is  to  be  repeated  fifteen  to  eighteen  times  a 
minute. 

Several  years  since  the  Michigan  State  Board  of  Health 
published  a  method  which  is  comprehensive,  effective,  easily 
understood,  and  readily  carried  out.  This  method  has  also  been 
adopted  by  the  United  States  Life-Saving  Service.  The  follow- 
ing are  the  details  of  the  Michigan  method: — 

Rule  1. — Remove  all  the  obstructions  to  breathing.  In- 
stantly loosen  or  cut  apart  all  neck-  and  waist-  bands ;  turn  the 
patient  on  his  face,  with  the  head  down  hill ;  stand  astride  the 
hips  with  your  face  toward  his  head,  and,  locking  your  fingers 
together  under  his  belly,  raise  the  body  as  high  as  you  can  with- 
out lifting  the  forehead  off  the  ground,  and  give  the  body  a 
smart  jerk  to  remove  mucus  from  the  throat  and  water  from  the 
windpipe,  hold  the  body  suspended  long  enough  to  slowly  count 
one — tioo — three — four — Jive,  repeating  the  jerk  more  gently 
two  or  three  times. 

Rule  2. — Place  the  patient  on  the  ground  face  downward, 
and,  maintaining  all  the  while  your  position  astride  the  body, 
grasp  the  points  of  the  shoulders  by  the  clothing;  or,  if  the  body  is 
naked,  thrust  your  fingers  into  the  armpits,  clasping  your  thumbs 
over  the  points  of  the  shoulders,  and  raise  the  chest  as  high  as 
you  can  without  lifting  the  head  quite  off  the  ground,  and  hold 
it  long  enough  to  slowly  count  one — tioo — three.  Replace  him 
on  the  ground  with  his  forehead  on  his  flexed  arm,  the  neck 


27£  TEXT-BOOK   OF   HYGIENE. 

straightened  out,  and  the  mouth  and  nose  free ;  place  your 
elbows  against  [the  inner  surface  of]  your  knees  and  your  hands 
upon  the  sides  of  his  chest  over  the  lower  ribs,  and  press  down- 
ward  and  inward  with  increasing  force  long  enough  to  slowly 
count  one — two.  Then  suddenly  let  go,  grasp  the  shoulders  as 
before,  and  raise  the  chest ;  then  press  upon  the  ribs,  etc.  These 
alternate  movements  should  be  repeated  ten  or  fifteen  times  a 
minute  for  an  hour,  at  least,  unless  breathing  is  restored  sooner. 
Use  the  same  regularity  as  in  natural  breathing. 

Rule  3. —  After  breathing  has  commenced  restore  the 
animal  heat.  Wrap  him  in  warm  blankets,  apply  bottles  of 
hot  water,  hot  bricks,  or  anything  to  restore  heat.  Warm  the 
head  nearly  as  fast  as  the  body  lest  convulsions  come  on.  Rub- 
bing the  body  with  warm  cloths  or  the  hands  and  slapping  the 
fleshy  parts  may  assist  to  restore  warmth  and  the  breathing  also. 

If  the  patient  can  surely  swallow,  give  hot  cofTee,  tea,  milk, 
or  a  little  hot  sling.  .  Give  spirits  sparingly,  lest  they  produce 
depression. 

Place  the  patient  in  a  warm  bed,  and  give  him  plenty  of 
fresh  air.     Keep  him  quiet. 

Beware !  Avoid  delay.  A  moment  may  turn  the  scale  for 
life  or  death.  Dry  ground,  shelter,  warmth,  stimulants,  etc.,  at 
this  moment  are  nothing — artificial  breathing  is  everything — is 
the  one  remedy — all  others  are  secondary.  Do  not  stop  to  re- 
move wet  clothing.  Precious  time  is  wasted,  and  the  patient 
may  be  fatally  chilled  by  exposure  of  the  naked  body,  even  in 
summer.  Give  all  your  attention  and  efforts  to  restore  breath- 
ing by  forcing  air  into,  and  out  of,  the  lungs.  If  the  breathing 
has  just  ceased,  a  smart  slap  on  the  face  or  a  vigorous  twist 
of  the  hair  will  sometimes  start  it  again,  and  may  be  tried  inci- 
dentally. Before  natural  breathing  is  fully  restored,  do  not  let 
the  patient  lie  on  his  back  unless  some  person  holds  the  tongue 
forward.  The  tongue  by  falling  back  may  close  the  windpipe 
and  cause  fatal  choking. 

Do  not  give  up  too  soon  ;  you  are  working  for  life.     Any 


PUBLIC    BATHS.  273 

time  within  two  hours  you  may  be  on  the  very  threshold  of 
success  without  there  being  any  sign  of  it.1 

PUBLIC    BATHS. 

In  all  large  cities  and  towns  provision  should  be  made  for 
free  public  baths,  conducted  under  official  supervision,  and  for 
the  especial  use  and  benefit  of  the  poorer  classes.  General 
cleanliness  is  not  merely  a  factor  in  the  preservation  of  the 
public  health,  but  there  is  good  reason  to  believe  that  the  cause 
of  good  order  and  decency  would  likewise  be  promoted  by 
furnishing  the  public  the  means  of  easily  and  cheaply  keeping 
clean.  Several  of  the  larger  cities  in  the  country  have  estab- 
lished public  baths  upon  a  limited  scale,  and  these  have  been 
very  popular  and  have  doubtless  been  of  great  benefit.  The 
author  has  shown 2  that  about  five-sixths  of  the  inhabitants  of 
the  large  cities  in  the  United  States  have  no  facilities  for  bathing 
except  such  as  are  afforded  by  a  pail  of  water  and  sponge,  or 
in  summer  the  proximity  of  some  body  of  water  easily 
accessible. 

1  Report  of  Michigan  State  Board  of  Health,  1874,  pp.  91-99. 

x  Address  in  State  Medicine,  Journal  American  Medical  Association,  July  2, 1887. 


18 


CHAPTER  XV. 

Clothing. 

The  primary  object  of  clothing  is  the  protection  of  the 
body  against  the  injurious  influences  of  heat,  cold,  and  moist- 
ure. Secondarily,  the  moral  sense  of  civilized  communities- 
demands  that  the  nude  human  body  shall  not  be  exposed  in 
public.  Hence,  there  are  moral  as  well  as  sanitary  reasons  for 
the  wearing  of  clothing ;  only  the  latter  can  be  considered  in 
this  place. 

Bodies  radiate  or  absorb  heat  accordingly  as  they  are  sur- 
rounded by  a  medium  having  a  lower  or  higher  temperature 
than  themselves.  In  order,  therefore,  to  avoid  chilling  of  the 
human  body,  if  exposed  to  a  temperature  below  37°  C.  (98°  F.), 
clothing  must  be  worn  to  prevent  or  retard  radiation  of  the 
body-heat.  Exposure  of  the  unprotected  body  to  a  low  tem- 
perature would  not  merely  cause  chilling  of  the  surface,  owing 
to  the  rapid  loss  of  heat,  but  would  incidentally  produce  con- 
gestion of  internal  organs  by  causing  constriction  of  the  super- 
ficial capillaries. 

Clothing  is  also  worn  as  a  protection  against  great  heat. 
The  head,  especially,  needs  protection  from  the  sun's  rays. 

CLOTHING    MATERIALS. 

The  materials  from  which  clothing  is  made  are,  princi- 
pally, cotton,  linen,  wool,  silk,  and  the  skins  of  animals.  Of 
these,  probably  the  most  universally  used  is  cotton.  It  is  cheap, 
durable,  does  not  shrink  when  wet,  absorbs  little  water,  and 
conducts  heat  readily.  It  is  therefore  especially  valuable  for 
summer  garments,  allowing  rapid  dissipation  of  the  body-heat 
and  evaporation  of  the  perspiration. 

Linen  conducts  heat  even  better  than  cotton,  and  is  for 

(275) 


276  TEXT-BOOK   OF   HYGIENE. 

this  reason  largely  used  for  summer  clothing.  Its  principal 
advantage  over  cotton  is  that  it  is  more  durable  and  less  harsh 
to  the  skin. 

Wool  absorbs  water  readily  and  is  a  bad  conductor  of  heat. 
It  is  therefore  valuable  as  a  winter  garment,  retarding  radiation 
from  the  body.  Woolen  undergarments  should  be  worn  at  all 
seasons,  in  order  to  prevent  too  rapid  changes  of  the  surface, 
and  so  invoking  diseases  depending  upon  chilling  of  the  body. 
Clothing  of  pure  wool  (flannels)  is  liable  to  irritate  the  skin 
of  some  persons.  A  mixture  of  wool  and  cotton,  known  as 
"  Saxony  wool,"  is  softer  and  less  irritating,  and  makes  a  serv- 
iceable substitute  for  pure  wool. 

Silk  is  often  used  for  undergarments.  It  is  light,  soft,  and 
a  bad  conductor  of  heat. 

The  skins  of  animals,  with  the  fur  on,  are  often  used  for 
outside  clothing.  They  furnish  great  protection  against  severe 
cold.  The  skin  is  impermeable  to  wind  and  rain,  while  the 
thick,  pilous  covering  of  fur  retards  to  a  very  great  degree  the 
radiation  of  heat.  In  British  America,  the  Northwestern 
States  and  Territories,  and  in  the  Arctic  regions,  the  use  of  skin 
clothing  is  necessary  for  comfort. 

As  a  protection  against  moisture  (rain  and  snow)  rubber 
cloth  is  used  for  overcoats,  etc.  While  it  serves  effectually  in 
keeping  out  the  rain,  it  prevents  evaporation  of  the  perspiration, 
increasing  the  liability  to  chill,  and  rendering  the  person  wear- 
ing it  very  uncomfortable,  except  in  cold  weather. 

Leather  is  used  almost  exclusively  in  the  manufacture  of 
foot-wear.  It  is  sometimes  used,  however,  for  other  articles  of 
clothing,  such  as  coats,  trowsers,  etc.  It  furnishes  most  effective 
protection  against  cold. 

The  color  of  the  clothing  is  of  great  importance.  Ex- 
posed to  the  sun,  white  wool  or  silk  absorb  very  little  more 
heat  than  linen  or  cotton,  but  the  same  material,  of  different 
colors,  when  exposed  to  the  sun's  rays,  exhibits  marked  differ- 
ences in  absorptive  capacity.     The  following  table  shows  the 


CLOTHING. 


277 


100  heat  units. 

102  < 

<    a 

140  ' 

<    « 

155  < 

c    u 

165  ' 

t          a 

168  ' 

i          a 

198  < 

(    a 

208  < 

i          a 

results  of  some  experiments  of  Pettenkofer.     The  material  used 
was  cotton  shirting  of  the  colors  named : — 

White  absorbed  .... 
Light  Sulphur  Yellow  absorbed 
Dark  Yellow  absorbed 
Light  Green  absorbed 
Turkey  Red  absorbed 
Dark  Green  absorbed 
Light  Blue  absorbed  . 
Black  absorbed  . 

When  protected  from  the  sun's  rays,  however,  the  material 
becomes  important  and  the  color  is  of  little  consequence.  Wool, 
being  a  bad  conductor  of  heat,  retards  radiation  from  the  body, 
and  is  hence  the  best  material  for  winter  clothing. 

Gases  and  vapors,  probably  also  disease-germs,  are  ab- 
sorbed by  clothing,  and  may  be  thus  conveyed  from  place  to 
place.  It  has  been  found  that  woolen  clothing  possesses  this 
power  of  absorption  to  a  much  greater  degree  than  linen  or 
cotton.  The  bad  odor  of  a  crowded  room  or  of  tobacco-smoke 
frequently  clings  to  woolen  garments  for  days,  although  they 
may  be  exposed  constantly  to  the  air  during  the  interval.  It 
would  be  advisable,  therefore,  that  physicians  attending  infec- 
tious diseases,  hospital  attendants  and  nurses,  should  wear  linen 
or  cotton  clothing  instead  of  woolen. 

Clothing  should  be  made  to  fit  properly.  It  should  not 
restrain  muscular  movements,  obstruct  the  circulation,  or  com- 
press organs.  Hence,  corsets,  belts,  and  garters  are  to  be  con- 
demned. It  is  a  fact  of  common  observation  that  moderately 
loose  clothing  is  warmer  than  close-fitting. 

Especial  attention  should  be  given  to  the  shape  and  fitting 
of  foot-wear.  Boots  and  shoes  are  usually  made  with  little 
regard  to  the  physiological  anatomy  of  the  foot,  and  as  a  result 
the  feet  of  most  Americans  are  deformed,  beauty  and  usefulness 
being  in  a  great  degree  sacrificed  to  the  Moloch  of  fashion.1 


1  See  a  practical  paper  by  Dr.  Benj.  Lee,  A  Shoe  That  Will  Not  Pinch,  in  Sanitarian  for 
June,  1884,  p.  493. 


278  '   TEXT-BOOK   OF   HYGIENE. 

Dyes  used  for  coloring  fabrics  are  sometimes  poisonous. 
The  author  has  repeatedly  seen  troublesome  eruptions,  and  even 
ulcerations  of  the  legs,  from  wearing  stockings  dyed  with  aniline 
compounds. 

By  appropriate  treatment  clothing  can  be  made  non- 
inflammable.  Tungstate  and  phosphate  of  soda  are  used  to 
reduce  the  inflammability  of  fabrics.  The  addition  of  20  per 
cent,  of  tungstate  of  soda  and  3  per  cent,  of  phosphate  of  soda 
to  the  starch-sizing  used  for  stiffening  linen  is  effective.  The 
material  is  not  injured  by  it,  and  a  smooth  surface  and  polish 
can  be  obtained  under  the  hot  iron.  Prof.  Kedzie  has  recom- 
mended borax  for  the  same  purpose.  He  says :  "  The  simplest 
and  easiest  way  to  make  your  cotton  and  linen  fabrics  safe  from 
taking  fire  is  to  dissolve  a  heaped  teaspoonful  of  powdered  borax 
in  \  pint  of  starch  solution.  It  does  not  injure  the  fabric, 
imparts  no  disagreeable  odor,  and  interferes  in  no  way  with  the 
subsequent  washing  of  the  goods.  It  does  not  prevent  the 
formation  of  a  smooth  and  polished  surface  in  the  process  of 
ironing.  Borax  can  be  found  in  every  village,  and  is  within 
the  reach  of  all.  It  is  a  cheap  salt,  and  its  use  for  this  purpose 
is  very  simple."1 

[The  following  works  may  also  be  studied  to  advantage: — 

Hammond,  Hygiene,  p.  5T9. — L.  Meyer,  Kleidung,  in  Realencyclo- 
psedie  d.  ges.  Heilk.,  Bd.  VII,  p.  446. — Van  Harlingen,  Care  of  the  Person, 
in  Buck's  Hygiene  and  Public  Health,  vol.  i.] 

1  Michigan  State  Board  of  Health,  p.  181.   1880. 


CHAPTER  XVI. 
Disposal  of  the  Dead. 

When  life  is  extinct  in  the  animal  body  decomposition 
begins.  This  may  be  either  putrefactive  or  non-putrefactive. 
The  difference  between  the  two  processes  has  been  explained  by 
Liebig.  In  putrefaction  of  organic  matters  only  the  elements 
of  water  take  part  in  the  formation  of  the  new  compounds  which 
result,  while  in  non-putrefactive  decomposition  or  decay  the 
oxygen  of  the  air  plays  an  important  part.  Putrefaction  can  go 
on  under  water,  while  decay  can  only  take  place  when  the 
supply  of  free  oxygen  is  abundant. 

The  prompt  removal  of  the  bodies  of  the  dead  from  the 
immediate  vicinity  of  the  living  is  a  matter  of  prime  sanitary 
importance.  If  death  results  from  a  contagious  or  an  infectious 
disease,  the  necessity  for  the  removal  of  the  corpse  is  evident. 
But,  even  where  there  is  no  danger  of  propagation  of  infectious 
disease,  the  products  of  putrefaction  and  decay  may  give  rise  to 
serious  derangements  of  health  if  allowed  to  pollute  the  air. 

The  chief  methods  of  disposal  of  the  dead  are  burial  in  the 
earth,  entombment  in  vaults,  and  cremation. 

INTERMENT. 

The  most  common  method  of  sepulture  is  burial  in  the 
earth.  The  corpse  is  usually  inclosed  in  a  case  (coffin)  of  wood 
or  metal,  and  buried  from  1  to  2  metres  deep.  Here  decom- 
position sets  in,  which  is  at  first  putrefactive  and  later  on  non- 
putrefactive.  In  the  course  of  several  years,  from  five  to  ten, 
the  entire  body,  with  the  exception  of  the  bones,  has  usually 
disappeared  and  become  converted  into  a  dry  mold. 

The  soil  of  a  burial-ground  should  be  dry  and  porous,  so 

(279) 


280  TEXT-BOOK   OF    HYGIENE. 

as  to  be  easily  permeated  by  the  air.  In  a  sandy  or  gravelly 
soil  the  decay  of  a  corpse  is  much  more  rapid  than  in  a  moist, 
clayey  soil.  In  the  latter  the  bodies  more  readily  undergo 
putrefaction,  or  become  converted  into  a  substance  termed  adi- 
pocere.  It  has  been  calculated  that  in  a  gravelly  soil  the  decay 
of  a  corpse  advances  as  much  in  one  year  as  it  would  in  sand  in 
one  and  two-thirds,  and  in  clay  in  two  to  two  and  one-third 
years.  The  decay  of  the  dead  bodies  is  principally  (if  not 
entirely)  dependent  upon  the  presence  of  living  vegetable  organ- 
isms. If  the  access  of  free  oxygen  is  prevented,  the  bacteria 
of  putrefaction  will  thrive  and  cause  putridity.  If,  however, 
the  soil  is  loose,  porous,  and  easily  permeable  by  the  air,  the 
bacteria  of  decay  will  be  present  and  produce  their  charac- 
teristic effects. 

The  barometric  pressure  seems  to  affect  the  decomposition 
of  dead  bodies.  For  example,  at  the  refuge  of  St.  Bernard,  in 
the  high  Alps,  the  bodies  of  those  dying  are  not  buried,  but 
exposed  to  the  air,  where  they  undergo  a  drying,  shrinking,  and 
mummification  instead  of  putrefaction  or  decay. 

Alternate  saturation  and  drying  of  the  soil  promotes  the 
rapidity  of  decay. 

Certain  occupations  are  said  to  produce  changes  in  the 
tissues  which  resist  decay.  Thus,  tanners  are  supposed  to  resist 
the  final  changes  of  the  tissues  longer  than  persons  of  other 
occupations.  Shakespeare  makes  the  grave-digger  in  Hamlet 
say:  "A  tanner  will  last  you  nine  years."  The  corpses  of  those 
poisoned  by  phosphorus,  arsenic,  sulphuric  acid,  or  corrosive 
sublimate  also  decay  more  slowly  than  those  of  cases  of  infectious 
diseases. 

All  the  tissues  may  be  converted  into  adipocere,  but  in  the 
large  majority  of  cases  only  the  fat  and  connective  tissue  undergo 
this  change. 

SUPPOSED    DANGERS    OF   BURIAL-GROUNDS. 

Popular  sanitary  literature  teems  with  supposed  instances 
of  the  injurious  influences  of  cemeteries  upon  the  health  of 


SUPPOSED    DANGERS   OF    BURIAL-GROUNDS.  281 

persons  living  in  their  vicinity.  An  unprejudiced  consideration 
of  the  subject  shows,  however,  that  there  is  no  trustworthy  evi- 
dence that  any  of  the  gases  exhaled  by  decaying  or  putrefying 
bodies  are  injurious  to  health.  The  air  of  closed  burial-vaults 
may  be  dangerous  from  the  large  proportion  of  carbon  dioxide 
contained  in  it,  but  the  other  gaseous  products  of  decomposition 
have  no  deleterious  effects.  The  dangers  to  health  from  the 
proximity  of  cemeteries  are  doubtless  very  much  exaggerated. 
Pettenkofer  and  Erismann  have  shown  that  a  single  large  privy- 
vault,  containing  about  17  cubic  metres  of  excrement,  gives  off 
nearly  as  large  an  amount  of  putrefactive  gases  in  the  course 
of  one  year  as  is  exhaled  by  a  burial-ground  containing  556 
decomposing  corpses  in  ten  years. 

Where  bodies  are  properly  buried,  and  the  ground  is  not 
overcharged  by  corpses,  it  is  not  probable  that  infectious  diseases 
are  propagated  from  interred  bodies.  There  are  no  facts  on 
record  which  show  that  such  an  event  has  occurred. 

The  dangers  of  pollution  of  water  by  cemeteries  have  also 
been  much  overestimated.  The  purifying  power  of  soil-strata, 
through  which  the  water  is  compelled  to  percolate  before  reach- 
ing the  well  after  becoming  charged  with  the  products  of  decom- 
position, is  in  most  cases  sufficient  to  remove  all  deleterious 
matters. 

Cemeteries  should  not  be  located  within  a  city,  but  must 
be  easily  accessible.  The  soil  should  be  dry  gravel  or  sand, 
with  a  low  ground-water  level.  The  graves  need  not  be  deeper 
than  1^  metres  to  the  top  of  the  coffin. 

ENTOMBMENT    IN    VAULTS. 

Burial-vaults  in  churches  or  in  the  open  air  should  be 
discountenanced.  The  gases  of  decomposition  are  given  off 
directly  to  the  air  without  the  modifying  power  of  the  soil,  and 
often  constitute  a  nuisance,  even  if  not  deleterious  to  health. 
Entombment  in  vaults  or  crypts  has  not  a  single  favorable 
circumstance  to  recommend  it. 


282  TEXT-BOOK   OF   HYGIENE. 

CREMATION. 

Within  recent  years  the  rapid  incineration  of  the  dead  in 
properly-constructed  furnaces  has  been  frequently  recommended. 
In  the  United  States  a  cremation  furnace  was  built  several  years 
ago  at  Washington,  Pa.,  by  the  late  Dr.  J.  C.  LeMoine.  Among 
the  remains  of  those  cremated  were  those  of  the  late  Dr.  Samuel 
D.  Gross,  the  distinguished  surgeon.  The  practice  has  not 
gained  very  many  adherents,  however,  although  cremation 
societies  have  been  organized  and  furnaces  built  in  several  of 
the  cities  throughout  the  country.  Aside  from  the  objections 
urged  by  the  more  conservative  classes,  who  desire  to  adhere  to 
the  time-honored  custom  of  interment,  serious  legal  objections 
have  been  brought  forward.  In  cases  where  poisoning  is 
suspected  some  time  after  death,  the  cremation  furnace  would 
have  destroyed  every  evidence  of  crime,  and  conviction  of  a 
criminal  poisoner  could  not  be  obtained. 

The  real  advantages  of  cremation,  such  as  rapid  destruction 
of  a  corpse,  economy  of  space  in  keeping  the  remains,  and 
avoidance  of  pollution  of  the  soil  by  decaying  bodies,  and  pos- 
sible pollution  of  air  and  water,  are  more  than  counterbalanced 
by  the  expense  and  the  medico-legal  objection  mentioned.  From 
a  sanitary  point  of  view,  cremation  is  not  necessary  in  this 
country.  A  proper  regulation  of  cemeteries  will  prevent  any 
possible  dangers  to  the  living  from  pollution  of  the  air,  soil,  or 
water  by  the  decaying  remains  of  human  beings. 

INTERMENT    ON   THE   BATTLE-FIELD. 

After  battles,  the  disposal  of  the  bodies  of  the  slain  is 
often  a  serious  problem.  Naegeli  proposes  the  following  method 
of  interment :  After  selecting  the  place  of  burial,  the  sod  and 
layer  of  humus  are  removed  from  a  sufficiently  large  surface  and 
thrown  to  one  side.  The  corpses  are  then  laid  upon  the  denuded 
place,  and  the  layers  of  corpses  separated  by  sand,  gravel,  or 
fine  brush-wood.  A  trench  is  then  dug  around  the  pile  of  dead 
and  the  soil  gained  is  thrown  over  the  corpses  until  they  are 


INTERMENT    ON    THE    BATTLE-FIELD.  283 

covered  to  a  depth  of  1  metre,  when  the  humus  and  sod  are 
placed  over  the  whole.  This  furnishes  a  dry  grave  in  which 
decay  rapidly  takes  the  place  of  putrefaction,  and  the  corpses 
soon  molder  away.  The  same  procedure  may  be  followed  in 
cases  of  epidemics  where  the  number  of  deaths  is  too  great  to 
properly  bury  them  in  single  graves. 


CHAPTER  XVII. 

The  Germ  Theory  of  Disease. 

The  ruling  doctrine  in  the  pathology  of  the  present  day  is 
the  germ  theory  of  disease.  Based  upon  the  doctrine  of  omne 
vivum  ex  vivo,  and  supported  by  strong  experimental  and  clinical 
evidence,  it  is  accepted  by  the  great  majority  of  physicians.  Its 
advocates  claim  that  the  large  class  of  diseases  known  as  con- 
tagious or  infectious  are  all  due  to  the  presence  in  the  blood  or 
tissues  of  minute  organisms,  either  animal  or  vegetable.  Many 
other  diseases,  not  at  present  included  in  the  above  class  by 
general  pathologists,  are  also  believed,  by  the  adherents  of  the 
germ  theory,  to  be  caused  in  the  same  way.  The  following  con- 
stitutes a  brief  review  of  the  most  prominent  facts  in  the  history 
of  the  doctrine  : — 

The  doctrine  of  the  vital  nature  of  the  contagium  of  dis- 
ease— the  contagium  animatum  of  the  older  writers — was  held 
in  a  vague  way  by  many  of  the  physicians  of  the  past,  but  it  was 
not  until  the  latter  part  of  the  last  century  that  the  theory  took 
definite  shape.  In  the  works  of  Hufeland,  Kirch er,  and  Linne 
the  idea  is  expressed  with  more  or  less  directness  that  the  propa- 
gation of  infectious  diseases  depends  upon  the  implantation  of 
minute  independent  organisms  into  or  upon  the  affected  indi- 
vidual. This  hypothesis  was,  however,  first  clearly  enunciated 
and  defended  with  great  force  by  Henle  in  1840.  Three  years 
earlier,  Cagniard  de  la  Tour  and  Schwann  had  established  a 
rational  basis  for  the  theory  by  their  observations  upon  the  yeast- 
plant  and  its  relation  to  fermentation.  In  1835  Bassi  had  dis- 
covered in  the  bodies  of  silk-worms  affected  by  muscardine,  sl 
disease  of  these  insects  which  proved  very  destructive,  a  para- 
site which  was  soon  shown  to  be  the  cause  of  the  disease. 
Within   the   next   few   years,   Tulasne,    DeBary,  and   Kuehn 

(285) 


286  TEXT-BOOK   OF   HYGIENE. 

proved  that  certain  fungi  were  the  causes  of  the  potato-rot  and 
other  diseases  of  plants.  Schoenlein,  Malmsten,  and  Gruby, 
between  1840  and  1845,  demonstrated  that  those  skin  diseases 
of  man  classed  as  the  tineas  were  due  entirely  to  the  action  of 
vegetable  parasitic  organisms. 

Up  to  this  time  the  germ  theory,  as  now  accepted,  had 
received  no  support  from  experiments.  All  the  diseases  claimed 
as  parasitic  were  purely  local ;  so  far  as  the  parasitic  nature  of 
the  general  diseases  was  concerned,  all  was  hypothetical.  In 
1849,  Guerin  Meneville  discovered  a  corpuscular  organism  in 
the  blood  of  silk-worms  affected  by  the  pebrine,  which  was  later 
proven  by  Pasteur  to  be  the  true  cause  of  this  destructive  dis- 
ease. Pollender,  in  1855,  and  Brauell,  in  1857,  found  numer- 
ous minute  rod-like  organisms  (bacteria)  in  the  blood  of  animals 
dead  from  splenic  fever.  In  1863  Davaine  investigated  the 
subject  more  fully,  and  showed  beyond  doubt  that  the  little 
organisms  discovered  by  Pollender  were  the  true  cause  of  splenic 
fever,  or  anthrax.  The  more  recent  researches  of  Robert  Koch 
upon  the  history  of  these  bacteria  or  bacilli  of  splenic  fever 
have  removed  all  doubt  of  their  etiological  significance. 

In  1883  the  last-named  observer  startled  the  medical  world 
by  the  assertion  that  consumption  or  tuberculosis  was  a  disease 
of  microbic  origin,  and  dependent  upon  the  presence,  in  the 
affected  tissues,  of  an  organism  which  he  named'  bacillus  tuber- 
culosis. Much  controversy  arose  upon  this  point,  but  Koch 
fortified  his  position  so  strongly  with  proofs,  both  experimental 
and  clinical,  that  it  may  now  be  regarded  as  fully  demonstrated. 
Koch  has  likewise  shown  (1885)  that  Asiatic  cholera  is  due  to 
a  bacterial  organism,  termed  by  him  the  "  comma  bacillus," 
from  its  shape.  It  is  generally  regarded  by  bacteriologists,  how- 
ever, to  belong  to  the  class  of  organisms  known  as  spirilla,  and 
not  to  the  bacilli.  Eberth  discovered  the  bacillus  which  is  now 
generally  accepted  as  the  cause  of  typhoid  in  1880;  Fehleisen, 
the  micrococcus  of  erysipelas  in  1883;  Obermeier,  the  spirillum 
of  relapsing  fever  in  1868;  Schutz  and  Loffler  discovered  the 


THE    GERM   THEORY    OF   DISEASE.  287 

bacillus  of  glanders  in  1882;  Neisser  announced  the  discovery 
of  the  micrococcus  of  gonorrhoea  in  1879.  The  bacillus  of 
leprosy  was  discovered  by  Hansen  in  1879.  The  micro-organ- 
isms of  malaria  (oscillaria  malarise),  which  are  believed  to  be 
animal  organisms,  were  discovered  by  Laveran  in  1881.  This 
organism  is  different  from  the  bacillus  malarice  of  Klebs  and 
Tommasi-Crudeli,  which  most  pathologists  do  not  regard  as  pos- 
sessing any  pathological  significance.  Pneumonia  may  also  be 
regarded  as  a  microbic  disease,  since  the  demonstrations  of 
Sternberg,  Weichselbaum,  and  Frankel  of  the  constant  presence 
of  the  micrococcus  Pasteurii  in  the  sputa  in  that  disease. 

The  careful  observations  and  researches  of  the  investigators 
mentioned,  as  well  as  of  many  others  who  have  worked  earn- 
estly in  this  field,  have  established  the  germ  theory  of  disease 
upon  a  secure  foundation.  For  the  diseases  mentioned  the 
parasitic  origin  may  be  accepted  as  fully  proven.  For  a  number 
of  others,  among  which  may  be  mentioned  small-pox,  yellow  fever, 
diphtheria,  scarlet  fever,  typhus  fever,  measles,  hydrophobia,  etc., 
the  etiological  connection  between  the  disease  and  certain  hypo- 
thetical organisms  not  yet  discovered  appears  probable. 

In  connection  with  the  germ  theory  there  has  arisen  of  late 
a  very  important  question  in  its  bearing  upon  preventive  medi- 
cine. This  is  the  value  of  the  so-called  protective  inoculations 
against  infectious  diseases.  The  protective  influence  of  vacci- 
nation against  small-pox  is  firmly  established  by  indubitable 
evidence.  Within  the  last  three  or  four  years  a  procedure  in- 
troduced by  Pasteur  to  protect  animals  against  certain  fatal  in- 
fectious diseases,  such  as  splenic  fever,  fowl-cholera,  and  rabies, 
has  claimed  much  attention.  Pasteur's  observations  were  first 
made  upon  the  disease  termed  chicken-cholera.  He  found  that 
the  blood  of  the  dead  fowls,  or  of  those  attacked  by  the  disease, 
swarmed  with  bacteria.  Inoculation  of  healthy  fowls  with  this 
diseased  blood,  or  with  the  bacteria  alone,  carefully  freed  from 
all  animal  fluids,  produced  the  same  disease.  The  bacteria 
were  therefore  assumed  to  be  the  cause  of  the  disease.     The 


288  TEXT-BOOK   OF   HYGIENE. 

investigator  then  took  a  quantity  of  these  bacteria  and  "  culti- 
vated "  them  through  a  number  of  generations,  using  sterilized 
chicken-broth  as  a  culture  medium.  Fowls  inoculated  with  the 
result  of  the  last  cultivation  were  still  attacked  by  the  same 
symptoms,  but  in  a  very  mild  degree,  and  almost  uniformly 
recovered  from  the  disease.  On  subsequent  inoculation  with 
infected  blood  no  effect  was  produced  upon  the  "  vaccinated " 
fowls,  while  the  same  blood  introduced  into  fowls  not  "  pro- 
tected "  by  the  previous  inoculation  produced  its  customary 
fatal  effect.  Pasteur  and  others  repeated  these  experiments 
with  the  organisms  found  in  the  blood  in  splenic  fever  and 
obtained  similar  results.  Inoculations  made  with  cultivations 
from  the  spinal  cord  of  animals  suffering  from  rabies  have  also 
been  claimed  as  protective  against  this  disease  and  hydrophobia. 
These  protective  inoculations  have  been  made  upon  large  num- 
bers of  sheep  and  cattle  within  the  past  three  years,  and  with 
very  remarkable  success.  Recently,  however,  it  has  been  shown 
that  the  protection  afforded  by  the  inoculation  is  a  very  tem- 
porary one,  and  that  after  a  variable  but  brief  interval  the  pro- 
tected animals  are  again  liable  to  be  fatally  attacked  by  the 
disease.  The  opinion  seems  to  be  justified  that  cultivation  pro- 
duces only  a  temporary  degeneration  of  the  bacteria, ,  which 
rapidly  disappears  when  the  organisms  are  again  brought  in 
relation  with  their  proper  nutritive  fluid.  The  "  protective  in- 
oculations "  produce  a  mild  attack  of  the  disease,  which  is  for  a 
time  a  bar  against  a  second  attack;  but  the  effect  soon  wears  off, 
leaving  the  animal  in  its  pristine  condition  of  receptivity  toward 
the  infective  material. 

[The  following  works  on  this  subject  are  recommended  to 
the  student : — 

Sternberg  and  Magnin,  The  Bacteria;  second  edition. — Fluegge, 
Fermente  nnd  Mikroparasiten,  in  von  Pettenkoffer  und  Ziemssen's 
Eumdbuch  d.  Hygiene.] 


CHAPTER  XVIII. 

Contagion  and  Infection. 

The  adjectives  "contagious"  and  "infectious"  are  used  to 
designate  certain  diseases  which  are  propagated  by  immediate 
contact,  or  through  the  intervention  of  some  other  medium,  from 
the  sick  to  the  healthy.  The  matters  in  which  reside  the  mor- 
bific power  are  now  believed  by  many  to  be  vegetable  organisms, 
but  not  a  few  pathologists  hold  to  the  view  that  the  real  con- 
tagia,  or  disease-bearing  agents,  are  modified  animal  cells  or 
abnormal  fluids. 

The  differentiation  between  contagion  and  infection  is  not 
easy.  Many  of  the  diseases  commonly  called  contagious  are 
also  infectious ;  that  is,  they  are  propagated  not  merely  by  direct 
contact,  but  also  by  air,  water,  or  food  which  may  have  become 
infected  with  the  morbific  agents.  Syphilis,  for  example,  may 
be  regarded  as  simply  a  contagious  disease ;  at  the  present  day, 
at  least,  we  cannot  conceive  syphilis  to  be  propagated  by  breath- 
ing infected  air  or  drinking  water  contaminated  with  the  poison 
of  syphilis.  Cholera,  typhoid,  and  yellow  fevers,  on  the  other 
hand,  are  examples  of  infectious  diseases,  neither  of  them  being 
directly  contagious,  but  conveyed  from  sick  to  well  through  the 
medium  of  contaminated  air,  water,  or  food.  Between  these 
two  stand  small-pox  and  typhus  fever  (and  perhaps  the  other 
exanthemata),  which  are  not  merely  contagious,  but  infectious 
also. 

There  is  still  a  third  class  of  acute  diseases  not  properly 
included  in  either  of  the  classes  mentioned.  This  is  the  class  of 
miasmatic  diseases,  of  which  malarial  fevers  are  the  type.  Ac- 
cording to  recent  observations,  pneumonia  ought,  perhaps,  to 
come  in  this  class. 

The   contagious  and  infectious  diseases  are  of  particular 

19  (289)      ' 


290  TEXT-BOOK    OF   HYGIENE. 

interest  to  sanitarians,  because  it  is  believed  that  by  judicious 
carrying  out  of  sanitary  measures  they  can  be  prevented.  Hence 
they  are  sometimes  termed  preventable  diseases.  Another  pecu- 
liarity of  the  infectious  diseases  is  that  they  usually  occur  in 
groups  of  cases.  Thus,  small-pox,  measles,  scarlet  fever,  typhus 
fever,  diphtheria,  and  others  of  the  class  do  not  occur  sporadi- 
cally, as  it  is  termed ;  that  is  to  say,  it  rarely  happens  that  only 
one  case  of  small-pox  is  observed  in  a  locality,  unless  active 
measures  are  at  once  taken  to  stamp  it  out.  Usually  a  number 
of  cases  occur  successively,  and  in  most  instances  the  succeeding 
cases  can  be  traced  ultimately  to  the  first  case. 

Contagious  and  infectious  diseases  frequently  appear  as 
epidemics.  Authorities  differ  as  to  the  proper  definition  of  an 
epidemic;  that  is,  given  the  population  of  a  place,  how  many 
cases  of  an  infectious  or  contagious  disease  are  necessary  before 
the  disease  can  be  considered  epidemic  at  such  place.  The 
following  formula  was  given  by  the  New  Orleans  Medical  and 
Surgical  Association  in  response  to  the  query,  "Under  what  cir- 
cumstances is  it  proper  to  declare  such  diseases  (diphtheria, 
scarlet  fever,  measles,  small-pox,  yellow  fever,  etc.)  epidemic  in 
a  place  V  The  answer  given  is  that  the  disease,  should  be 
declared  epidemic  when  the  number  of  cases  should  reach  these 
proportions1 : — 

For  a  population  of 


100   . 

5  per  cent. 

500   . 

4  "   " 

2,000  to   5,000  . 

22|  "  thousand. 

6,000  to  10,000  . 

16~  "     " 

20,000  to  50,000  . 

8  "  ten  thousand, 

50,000  to  100,000  . 

4  a         a              u 

200,000  . 

i  u        u     a 

A  disease  is  said  to  be  pandemic  when  it  spreads  rapidly 
over  a  great  extent  of  country,  and  endemic  when  it  is  constantly 
present  in  a  place.  Diseases  which  may  be  prevalent  in  certain 
localities,  i.e.,  endemic,  not  infrequently  spread  over  larger  areas 


1  Public  Health,  vol.  vi,  pp.  416,  417. 


CONTAGION   AND    INFECTION,  291 

of  country, — overflow  their  borders,  as  it  were, — and  become  epi- 
demic or  pandemic.  Thus  cholera,  which  is  endemic  in  certain 
districts  of  India,  frequently  spreads  over  adjacent  territory,  and 
at  times  the  epidemic  wave,  as  it  has  been  called,  rolls  over 
nearly  the  whole  world.  Plague,  malarial  and  yellow  fevers 
make  similar  epidemic  excursions  into  other  countries,  or  sec- 
tions of  country,  at  a  distance  from  the  places  where  they  are 
endemic. 

Contagious  and  infectious  diseases  possess  another  peculi- 
arity in  that  a  certain  time  is  required  after  the  introduction  of 
the  poison  into  the  system  before  the  disease  manifests  itself  by 
its  typical  symptoms.  This  is  called  the  "stage  of  incubation," 
and  varies  for  different  diseases.  The  following  table  shows  the 
stage  of  incubation  of  a  number  of  such  diseases : — 

Table  XXVI. 

INCUBATION   OF   INFECTIOUS   DISEASES. 

Measles, 10  days. 

Small-pox, 12  " 

Mumps, 18  " 

Diphtheria,        .         .         „         .         .         .         .  3  " 

Scarlet  fever, 3  " 

Whooping-cough, 14  " 

Typhoid  fever, 14  " 

Typhus  fever,  . 1  to  2  " 

Chicken-pox,     .                  4  " 

Erysipelas, 4  " 

The  period  during  which  the  infectiveness  of  the  patient 
lasts  also  varies.  In  some  cases  it  probably  depends  upon  the 
measures  taken  to  prevent  the  spread  of  the  disease,  e.g.,  disin- 
fection of  the  patient  and  his  surroundings. 


CHAPTER  XIX. 

History  of  Epidemic  Diseases. 

An  important  part  of  the  knowledge  of  the  sanitarian  is 
that  which  relates  to  the  history  of  the  great  epidemic  diseases 
which  have  at  various  periods  devastated  large  areas  of  the  in- 
habited world.  In  this  chapter  the  history  of  these  diseases  will 
be  briefly  traced.  Although  some  of  these  diseases  have  nearly 
or  quite  ceased,  a  knowledge  of  their  habits  and  of  the  causes 
that  finally  led  to  their  extinction  is  of  great  value,  for  the  reason 
that  the  principles  and  measures  of  prevention  which  were 
effective  in  times  past  are  the  same  which  must  apply  at  pres- 
ent and  in  the  future.  Hence,  time  spent  in  looking  back  over 
the  fields  traversed  and  noting  victories  won  will  not  be  wasted. 

The  epidemic  diseases  which  will  here  claim  attention  are 
the  Oriental  plague,  the  sweating  sickness,  small-pox,  Asiatic 
cholera ;  typhus,  typhoid,  scarlet,  relapsing,  and  yellow  fevers ; 
diphtheria,  dengue,  epidemic  influenza,  and  syphilis.  In  addi- 
tion, some  information  will  be  given  on  certain  of  the  diseases 
of  animals  transmissible  to  man.  Among  these  are  sheep-pock, 
actinomycosis,  bovine  tuberculosis  (perlsucht),  rabies,  anthrax 
(milzbrand),  and  glanders. 

THE  ORIENTAL  PLAGUE. 

The  Oriental  plague,  bubonic  plague,  the  black  death,  or 
simply  the  "  plague,"  or  great  pestilence,  overtopping  in  its 
fatality  all  other  pestilences,  is  mentioned  by  a  number  of  the 
Greek  and  Latin  medical  authors.  The  first  account  which 
clearly  refers  only  to  this  disease  is  given  by  Procopius.  Ac- 
cording to  this  and  other  contemporary  authors,  the  disease  be- 
gan to  spread  in  the  year  542  from  Lower  Egypt,  passing  in  one 
direction  along  the  coast  of  Northern  Africa,  and  in  the  other 

(293) 


294  TEXT-BOOK   OF   HYGIENE. 

invading  Europe  by  way  of  Syria  and  Palestine.  In  the  course 
of  the  succeeding  years  this  pandemic  reached  "the  limits  of  the 
inhabited  earth,"  in  the  language  of  the  writers  of  the  day.  The 
disease  prevailed  about  half  a  century,  and  produced  the  greatest 
devastation  wherever  it  appeared.  "  Cities  were  devastated,  the 
country  converted  into  a  desert,  and  the  wild  beasts  found  an 
asylum  in  the  abandoned  haunts  of  man."1 

The  plague  is  an  acute  infectious  disease,  which  is  char- 
acterized by  an  affection  of  the  lymphatic  system,  i.e.,  inflam- 
mation and  swelling  of  the  external  and  internal  lymphatic 
glands.  Accessory  symptoms  are  petechial  spots  upon  the  skin, 
and  haemorrhages  from  various  organs,  as  the  stomach,  nose, 
kidneys,  rectum,  and  uterus.  Those  attacked  suffer  in  varied 
degrees  of  intensity.  In  some,  a  fulminant  form  occurs  which 
carries  off  the  patient  within  three  days ;  there  is  another  class 
of  cases  in  which  buboes  develop,  with  accompanying  fever  and 
haemorrhages;  and,  finally,  a  light  form,  rarely  fatal,  in  which 
only  the  local  symptoms  are  manifested.  In  the  great  pan- 
demic of  the  plague  in  the  fourteenth  century  cough  and  bloody 
expectorations  were  very  frequent.  In  the  later  epidemics 
haemorrhage  from  the  lungs  has  been  rarely  noticed  as  a  symptom. 

About  the  middle  of  the  fourteenth  century  the  bubonic 
plague  made  a  second  incursion  into  Europe  from  i  its  home  in 
the  East.  A  most  graphic  description  of  its  ravages  is  given  by 
Boccaccio  in  the  "  Decameron."  This  author  states  that  in  1359, 
"  between  March  and  July  following,  according  to  authentic 
reckonings,  upward  of  100,000  souls  perished  in  the  city 
(Florence) ;  whereas,  before  that  calamity  it  was  not  supposed 
to  contain  so  many  inhabitants." 

This  terrible  epidemic  was  forcibly  characterized  by  its  com- 
mon name,  "  the  black  death."  Hecker  estimates  that  during  its 
continuance,  from  1347  to  1351,  25,000,000 — one-fourth  of  the 
probable  total  population  of  Europe — died.  In  various  cities 
the  mortality  was — in  London,  100,000;  in  Paris,  50,000;  in 

1  Warnefried,  quoted  by  Hirsch,  Hist-Geographische  Pathologie,  I,  p.  350. 


THE  ORIENTAL  PLAGUE.  295 

Venice,  100,000  ;  in  Avignon,  60,000  ;  in  Marseilles,  16,000,  in 
one  month.  It  was  said  that  in  all  England  scarcely  a  tenth 
part  of  the  population  escaped  death  from  the  disease. 

The  moral  effects  of  this  great  pandemic  of  the  plague  were 
hardly  less  deplorable  than  the  physical.  Religious  fanaticism 
held  full  sway  throughout  Europe,  finding  its  vent  in  all  manner 
of  excesses.  The  so-called  Brotherhood  of  the  Cross,  otherwise 
known  as  the  Order  of  Flagellants,  which  had  arisen  in  the 
thirteenth  century,  but  had  been  suppressed  by  the  ecclesiastical 
authorities,  was  revived  during  the  black  pestilence,  and  large 
numbers  of  these  religious  enthusiasts  roamed  through  the 
various  countries  on  their  great  pilgrimages.  Their  power  in- 
creased to  such  a  degree  that  Church  and  State  were  forced  to 
combine  for  their  suppression.  One  consequence  of  this  fanat- 
ical frenzy  was  the  persecution  of  the  Jews.  These  were  accused 
of  being  the  cause  of  every  evil  that  befell  mankind,  and  many 
were  put  to  death. 

In  the  fifteenth  and  sixteenth  centuries  the  plague  was 
generally  diffused  throughout  Europe,  and  in  the  second  third 
of  the  seventeenth  century  its  final  incursion  into  the  Occident 
took  place.  The  great  epidemic  in  London,  so  graphically  de- 
scribed by  Defoe,1  occurred  in  1665.  In  the  early  part  of  the 
eighteenth  century  (1720)  the  plague  visited  Marseilles  and 
Toulon;  from  1769  to  1772  it  was  epidemic  in  Moldavia,  Wal- 
lachia,  Poland,  and  Southern  Russia ;  near  the  close  of  the  last, 
and  again  in  the  beginning  of  the  present  century,  in  Transyl- 
vania, Wallachia,  Southern  Russia,  and  Greece.  Very  recently, 
in  1878  and  1879,  and  again  in  1885,  the  plague  threatened  a 
new  irruption  into  European  territory,  being  epidemic  in  the 
district  of  Astrachan,  on  the  Caspian  Sea. 

Although  the  bubonic  plague  has  never  been  observed  in 
America,  and  has  spared  Europe  almost  entirely  during  the  present 
century,  it  still  persists  in  certain  countries  of  Asia  and  Africa, 
especially  in  Arabia,  Mesopotamia,  Persia,  and  the  coast  of  Tripoli. 

1  Journal  of  the  Plague  in  London. 


296  TEXT-BOOK   OF   HYGIENE. 

The  older  authors  ascribed  the  origin  of  the  plague  to 
various  real  or  supposed  conditions.  Comets,  conjunctions  of 
the  planets,  "  God's  just  punishment  for  our  sins,"  and  similar 
causes  were  advanced  to  account  for  the  outbreaks.  Most  of  the 
writers  of  the  post-mediseval  and  modern  epochs  ascribed  the 
disease  to  meteorological  conditions.  Observing  the  fact  that  the 
plague  never  advanced  into  the  torrid  zone,  and  that  an  epidemic 
generally  ended  with  the  advent  of  hot  weather,  a  high  tempera- 
ture was  believed  to  be  incompatible  with  the  existence  of  an 
epidemic,  and  a  cold  or  temperate  climate  was  considered  neces- 
sary to  an  outbreak  of  the  disease.  The  exceptions  to  the  rule 
are  so  numerous,  however,  that  the  theory  of  the  climatic  or 
meteorological  origin  of  the  plague  failed  of  support.  The  theory 
which  ascribed  the  origin  of  the  epidemics  to  the  influence  of 
certain  hot  and  dry  winds  or  a  high  humidity  is  also  insufficient. 
Certain  geological  formations  have  been  supposed  to  furnish 
favorable  conditions  for  the  development  of  tbe  disease.  Facts 
show,  however,  that  the  disease  has  prevailed  epidemically  and 
endemically  in  various  parts  of  the  earth,  and  of  the  most  diverse 
geological  character.  A  certain  elevation  above  sea-level  has 
been  held  to  confer  immunity,  but  recent  observations  in  India 
show  that  this  belief  is  unfounded,  even  places  at  an  elevation 
of  10,000  feet  above  sea-level  giving  no  security  against  attack. 

There  is,  however,  one  point  upon  which  nearly  all  writers 
who  mention  the  fact  at  all  agree.  This  is  that  bad  hygienic 
conditions  are  always  present  where  plague  prevails.  Nearly  all 
observers  who  have  left  their  impressions  on  record  mention  the 
accumulation  of  filth  in  the  houses  and  streets,  deficient  removal 
of  excrementitious  and  other  sewage  matters,  crowding  and  im- 
perfect ventilation  of  dwellings  as  causes  favoring  the  develop- 
ment and  spread  of  the  pestilence.  All  point  out  the  necessity 
of  the  removal  of  these  evils  as  the  most  important  prophylactic 
measure  to  be  adopted,  and  all  of  them  call  attention  to  the  fact 
that  those  classes  of  the  population  most  exposed  to  these  unfa- 
vorable influences  suffer  most  from  the  violence  of  the  epidemic. 


THE    ORIENTAL    PLAGUE.  297 

The  later  reports  of  the  epidemics  in  Persia,  India,  Mesopo- 
tamia, and  Russia  agree  in  asserting  that  nothing  seems  to  have 
promoted  the  epidemic  and  endemic  prevalence  of  the  plague  so 
much  as  the  material  wretchedness  of  the  inhabitants  of  those 
countries.  In  a  collection  of  papers  on  the  plague,  printed  by 
a  British  Parliamentary  Commission  in  1879,  occur  these  state- 
ments :  "  The  filth  is  everywhere,"  says  Mr.  Rennie,  one  of  the 
reporters, — "  in  their  villages,  their  houses,  and  their  persons. 
Their  dwellings  are  generally  low  and  ill-ventilated,  except 
through  their  bad  construction ;  and  the  advantage  of  the 
natives  in  other  parts  of  India,  of  living  in  the  open  air,  is  lost 
to  the  villagers  of  Ghurwal,  from  the  necessity  of  their  crowding 
together  for  mutual  warmth  and  shelter  against  the  inclemency 
of  the  weather."  Dr.  Dickson,  reporting  on  the  plague  in  Irak 
Arabi  in  1876,  says:  "  The  most  palpable  and  evident  of  all  the 
causes  which  predispose  an  individual  to  an  attack  of  plague 
during  an  epidemic  outbreak  is  poverty.  No  other  malady  shows 
the  influence  of  this  factor  in  so  striking  a  degree ;  so  much  so, 
indeed,  that  Dr.  Cabiadis  styles  the  plague  miserice  raorbis.  In 
his  experience  (1876-77,  in  Bagdad)  he  found  that  the  poor 
were  seldom  spared,  the  wealthy  hardly  ever  attacked."1 

The  manner  of  the  transmission  of  the  plague  is  generally 
by  prolonged  inhalation  of  an  infected  atmosphere.  Hence,  it 
may  be  termed  an  infectious  disease,  although  it  is  not  improbable 
that  it  may  be  communicated  by  direct  contact  both  of  persons 
and  of  fomites.  It  is  probably  due  to  a  micro-organism,  although 
no  demonstration  of  the  latter  has  been  furnished  up  to  the 
present  time. 

These  considerations  indicate  the  measures  of  prevention 
to  be  adopted.  They  consist  of  a  rigid  quarantine  of  persons 
and  fomites,  prompt  and  complete  isolation  of  infected  individuals 
and  localities,  and  destruction  (by  fire)  or  thorough  disinfection 
by  steam  or  sulphurous-acid  gas  of  all  materials  capable  of  con- 
veying the  virus  of  the  disease. 

»  Hirsch,  op.  cit.,  p.  370. 


298  TEXT-BOOK   OF    HYGIENE. 

THE    SWEATING    SICKNESS. 

This  name  concisely  characterizes  an  epidemic  disease 
which  for  the  first  time  appeared  in  the  city  of  London  and 
other  parts  of  England  in  the  autumn  of  1485.  According  to 
Lord  Bacon,1  the  disease  began  about  the  21st  of  September 
and  lasted  until  near  the  end  of  October.  It  broke  out  a  second 
time  in  the  summer  of  1507;  a  third  time  in  July,  1518,  spread- 
ing in  the  course  of  six  months  throughout  England.  In  May, 
1529,  the  disease  made  its  appearance  again  in  the  latter  country, 
spreading  thence  over  a  great  part  of  the  continent  of  Europe. 
Another  very  malignant  epidemic  broke  out  in  the  spring  of 
15-11,  lasting  through  the  summer,  and  limited  in  its  ravages  to 
England. 

With  this  last  outbreak,  in  1551,  this  disease  disappeared 
entirely  in  England  and  has  not  re-appeared  there  up  to  the 
present  day.  In  the  beginning  of  the  eighteenth  century,  how- 
ever, a  disease  very  similar  in  its  symptoms  and  course  broke  out 
in  Picardy  and  other  districts  of  Northern  France,  being  confined 
for  a  number  of  years  to  this  section  of  the  country.  Toward 
the  end  of  the  century  it  spread  to  the  south  of  France,  and 
since  that  time  has  appeared  epidemically  at  intervals,  195  dis- 
tinct outbreaks  having  been  observed  in  the  course  of  168  years, 
from  1718  to  1887.  The  disease  has  frequently  appeared  in  Italy 
since  1755,  and  in  various  parts  of  Germany  since  1801.  In 
Belgium  it  has  been  observed  at  a  few  places  within  the  present 
century. 

The  disease  appeared  suddenly,  often  at  night-time.  The 
patient  was  attacked  with  palpitation  of  the  heart,  dyspnoea, 
great  anxiety  and  oppression,  and  profuse  perspiration.  A 
miliary  eruption  often  appeared  on  the  skin.  In  favorable  cases 
these  symptoms  diminished  in  the  course  of  one  or  two  days,  the 
urinary  secretion,  which  had  been  suppressed,  was  restored,  and 
the  perspiration  became  gradually  less  free.  Recovery  ensued 
in  from  one  to  two  weeks.     In  grave  cases  there  were,  in  the 

»  History  of  Henry  VII. 


SMALL-POX.  299 

beginning  of  the  attack,  violent  headache,  delirium,  convulsions, 
followed  by  a  comatose  condition,  from  which  the  patients  rarely 
recovered. 

This  disease  is  undoubtedly  of  a  miasmatic,  infectious  nature, 
as  proved  by  its  rapid  spread  and  limitation  to  certain  localities. 
It  appears  most  frequently  in  the  spring  and  summer,  and  is 
nearly  always  observed  in  marshy  or  damp  localities.  Its  spread 
is  favored  by  a  high  temperature  and  humidity.  There  is  no 
apparent  connection  between  the  outbreaks  of  the  sweating 
sickness  and  overcrowding  or  other  insanitary  conditions ;  in 
fact,  it  is  stated  by  numerous  observers,  both  old  and  recent,  that 
children,  the  aged,  and  generally  the  poorer  classes  were  remark- 1 
ably  exempt  from  the  disease.  The  recent  epidemic  in  France, 
in  1887,  was  investigated  by  Dr.  Brouardel,  Chantemesse.  and 
other  epidemiologists,  but  no  trustworthy  conclusions  as  to  the 
nature  of  the  disease  have  yet  been  reached. 

Since  the  first  appearance  of  Asiatic  cholera  in  France,  in 
1832,  an  apparently  intimate  connection  has  been  observed 
between  the  occurrence  of  that  disease  and  outbreaks  of  sweating 
sickness.  A  disease  strongly  resembling  the  sweating  sickness 
has  also  been  observed  in  India  in  districts  contiguous  to  places 
where  cholera  was  at  the  time  epidemic.1 

SMALL-POX. 

The  earliest  details  concerning  small-pox  are  derived  from 
certain  Chinese  records,  according  to  which  it  appears  that  this 
disease  was  known  in  China  upward  of  2000  years  ago.  It  was 
also  known  at  a  very  early  period  in  India.  It  is  believed  to 
have  been  introduced  into  Europe  in  the  second  century  by  a 
Roman  army  returning  from  Asia.  It  is  believed  that  the  Em- 
peror Marcus  Aurelius  died  of  small-pox,  which  prevailed  in  his 
army  at  the  time  of  his  death. 

The  first  distinct  references  to  small-pox  in  medical  literature 
occur  in  the  writings  of  Galen,  in  the  second  century.     Rhazes, 

1  Murray,  Madras  Quart.  Med.  Journ.,  1840-41.    Quoted  in  Hirsch,  loc.  cit.,  p.  83. 


300  TEXT-BOOK    OF    HYGIENE. 

in  the  ninth  century,  wrote  upon  the  disease,  describing  it  very 
accurately. 

The  almost  universal  susceptibility  to  small-pox  caused 
wide-spread  devastation  wherever  it  appeared  previous  to  the 
introduction  of  vaccination.  The  statement  is  made  that  in 
England,  in  the  last  century,  about  one  person  in  every  three 
was  badly  pock-marked.  The  mortality  from  the  disease  was 
exceedingly  great,  being,  in  the  latter  half  of  the  eighteenth 
century,  about  3000  per  million  of  inhabitants  annually. 

In  India  the  mortality  from  small-pox  has  been  exceedingly 
great  within  the  last  twenty  years.  From  1866  to  1869,  140,000 
persons  died  in  the  Presidencies  of  Bombay  and  Calcutta,  having 
a  population  of  about  40,000,000.  Several  years  later,  from 
1873  to  1876,  700,000  died  from  this  disease. 

China,  Japan,  Cochin  China,  the  islands  of  the  China  Sea, 
and  Corea  are  frequently  ravaged  by  small-pox.  In  the  latter 
country  nearly  all  the  inhabitants  are  said  to  bear  evidence  of 
an  attack  of  the  disease. 

The  Samoyedes,  Ostiaks,  and  other  natives  of  Eastern  Siberia 
have  frequently  suffered  from  devastating  epidemics.  In  Kamt- 
chatka  the  disease  was  introduced  in  1767,  and  produced 
frightful  ravages.     Many  villages  were  completely  depopulated. 

In  Mexico  small-pox  was  introduced  by  the  Spaniards  in 
1520.  In  a  short  time  it  carried  off  over  3,500,000  of  the 
natives.  In  the  Marquesas  Islands  one-fourth  of  the  inhabitants 
have  fallen  victims  to  the  disease  since  1863. 

It  was  first  introduced  into  the  Sandwich  Islands  in  1853, 
and  carried  off  8  per  cent,  of  the  natives. 

Australia,  Tasmania,  New  Zealand,  and  the  Fejee  Archi- 
pelago remain  exempt  to  the  present  day  from  small-pox.  It  has 
several  times  been  carried  to  Australia  by  vessels,  but  has  always 
been  promptly  checked  by  the  vigilance  of  the  authorities. 

On  the  Western  Hemisphere  small-pox  was  unknown  before 
the  arrival  of  the  European  conquerors.  It  has  been  spread  by 
the  whites  or  imported  African  slaves  to  nearly  all  the  Indian 


SMALL-POX.  301 

tribes  of  both  continents.  When  it  attacks  large  communities 
unprotected  by  previous  outbreaks  of  the  disease,  or  by  inocula- 
tion or  vaccination,  its  ravages  are  frightful.  The  mortality  of 
unmodified  small-pox  is  usually  between  30  and  40  per  cent. 

Small-pox  is  a  highly  contagious  and  infectious  disease. 
It  is  produced  by  actual  contact,  by  inoculation,  and  by  inhaling 
an  atmosphere  charged  with  the  poison.  In  order  to  cause  an 
outbreak  two  factors  are  necessary :  first,  a  number  of  individuals 
susceptible  to  this  disease,  and,  second,  the  introduction  into  the 
body,  in  some  manner,  of  the  virus  upon  which  it  depends. 

Small-pox  is  spread  from  (1)  persons  sick  with  the  disease; 
(2)  others,  not  themselves  sick  or  susceptible,  but  coming  in 
contact  with  the  poison;  (3)  fomites  (cotton,  wool,  etc.),  and  (4) 
the  bodies  of  persons  dead  with  small-pox.  It  is  also  probable 
that  the  air  in  the  immediate  vicinity  of  a  person  sick  with  small- 
pox becomes  charged  with  the  poison  and  able  to  convey  the 
disease.  It  is  at  present  impossible  to  fix  the  distance  to  which 
this  infectiousness  of  the  air  extends,  but  it  does  not  ordinarily 
reach  beyond  the  room  in  which  the  patient  is  confined. 

It  is  a  fact  of  common  observation  that  the  darker  races 
are  more  commonly  attacked,  and  the  disease  is  likewise  more 
fatal  among  them.  The  mortality  among  negroes  is  much  larger 
than  among  other  races. 

It  is  a  current  belief  that  small-pox  is  only  contagious  after 
the  development  of  the  pustules.  This  is  a  serious  error.  It  is 
probably  contagious  in  all  stages  of  the  disease ;  certainly  as 
early  as  the  first  appearance  of  the  eruption,  and  probably  even 
in  the  stage  of  preliminary  fever. 

One  attack  of  small-pox  usually  confers  immunity  from  the 
disease  for  life.  This  rule  has  its  exceptions,  however,  which,  if 
not  numerous,  are  yet  not  infrequent.  The  author  has  seen  a 
case  in  which  the  patient  suffered  from  a  third  attack  of  the 
disease. 

The  popular  belief,  that  persons  suffering  from  any  acute 
or  chronic  disease  are  less  liable  to  be  attacked  by  small-pox 


302 


TEXT-BOOK   OF    HYGIENE. 


than  those  at  the  time  in  good  health,  is  erroneous.  On  the 
contrary,  the  subjects  of  chronic  disease,  such  as  consumption  or 
dyspepsia,  are  much  more  liable  to  succumb  to  an  attack  of 
small-pox  than  persons  previously  in  good  health. 

It  is  true,  however,  that  individuals  suffering  from  some 
other  acute  infections  disease,  like  scarlet  fever,  measles,  typhoid 
fever,  etc.,  are  generally,  though  not  absolutely,  exempt  from 
an  attack  of  small-pox  during  the  time  they  are  sick  with  such 
disease.  But  if  they  are  exposed,  after  recovery,  to  the  small- 
pox infection,  their  liability  to  an  attack  is  as  great  as  in  those 
who  have  not  passed  through  a  similar  disease.  A  number  of 
cases  have  been  reported  by  Curschmann,1  in  which  infection 
by  small-pox  took  place  on  the  day  in  which  convalescence  from 
typhoid  fever  was  established. 

The  author  has  reported  a  case2  in  which  the  patient  passed 
through  an  attack  of  erysipelas  during  the  incubative  stage  of 
small-pox.  From  all  the  evidence  attainable,  the  incubative  stage 
was  not  prolonged  by  the  intercurrent  erysipelas. 

Epidemics  of  small-pox  usually  begin  in  the  autumn  or 
winter,  and  lessen  in  violence  as  warmer  weather  approaches. 
The  spread  of  the  disease  is  slow  at  first,  increasing  in  rapidity 
as  the  foci  of  infection  multiply. 

When  the  poison  is  imported  into  a  community  late  in  the 
spring  or  during  the  summer,  the  increase  in  the  number  of 
cases  is  exceedingly  gradual  until  colder  weather  sets  in.  If  it 
is  introduced  during  the  winter,  the  disease  spreads  much  more 
rapidly,  but  decreases,  and  sometimes  almost  disappears,  during 
the  summer.  On  the  return  of  cold  weather,  however,  the  epi- 
demic starts  out  with  a  new  lease  of  activity  and  presents  great 
difficulties  to  its  restriction. 

A  number  of  observers,  among  whom  are  Coze  and  Feltz, 
Lugenbuhl, ' Weigert,  Strauss,  Garre,  and  Wolff,  claim  to  have 
discovered  specific  organisms  in  the  contents  of  variolous  pustules, 
in  the  blood  of  patients  with  the  disease,  and  in  vaccine  lymph. 

1  Ziemssen's  Cyclopaedia,  vol.  ii.  a  Medical  News,  July  7, 1883. 


SMALL-POX.  303 

Expert  bacteriologists  are,  however,  not  willing  to  accept  the 
evidence  hitherto  furnished  as  conclusive. 

Inoculation. — The  prevention  or  restriction  of  such  a  uni- 
versal and  fatal  pestilence  as  small-pox  is  a  matter  of  the  deepest 
importance.  The  first  attempt  to  limit  its  fatality  dates  from  the 
end  of  the  seventeenth  century.  It  became  generally  known  in 
Europe,  about  the  year  1700,  that  the  intentional  inoculation  of 
variolous  matter  into  healthy  individuals  induced  an  attack  of 
the  disease,  which  generally  ran  through  its  various  stages  with 
less  virulence  than  when  the  disease  was  contracted  in  the  usual 
manner.  In  1716  and  1717  two  papers  were  published  in  the 
"  Transactions  of  the  Royal  Society  of  England"  giving  an  ac- 
count of  the  process  of  inoculation.  The  attention  of  the  public 
was  especially  directed  to  the  matter,  however,  by  the  famous 
letter  of  Lady  Mary  Wortley  Montagu,  dated  April  1,1717.  This 
letter  is  as  follows1:  "Apropos  of  distempers,  I  am  going  to  tell 
you  a  thing  that  will  make  you  wish  yourself  here.  The  small- 
pox, so  fatal  and  so  general  amongst  us,  is  here  entirely  harm- 
less by  the  invention  of  ingrafting,  which  is  the  term  they  give 
it.  There  is  a  set  of  old  women  who  make  it  their  business  to 
perform  the  operation  every  autumn,  in  the  month  of  September, 
when  the  great  heat  is  abated.  People  send  to  one  another  to 
know  if  any  of  their  family  has  a  mind  to  have  the  small-pox ; 
they  make  parties  for  this  purpose,  and  when  they  are  met — 
commonly  fifteen  or  sixteen  together — the  old  woman  comes 
with  a  nut-shell  full  of  the  matter  of  the  best  sort  of  small-pox, 
and  asks  what  veins  you  please  to  have  opened.  She  immediately 
rips  open  that  you  offer  to  her  with  a  large  needle — which  gives 
you  no  more  pain  than  a  common  scratch — and  puts  into  the 
vein  as  much  matter  as  can  lie  upon  the  head  of  her  needle, 
and  after  that  binds  up  the  little  wound  with  a  hollow  bit  of 
shell ;  and  in  this  manner  opens  four  or  five  veins.  The  Grecians 
have  commonly  the  superstition  of  opening  one  in  the  middle 
of  the  forehead,  one  in  each  arm,  and  one  on  the  breast,  to  make 

1  The  letter  is  addressed  to  Mrs.  S.  C.  (Sarah  Chiswell). 


304  TEXT-BOOK   OF   HYGIENE. 

the  sign  of  the  cross ;  but  this  has  a  very  ill  effect,  all  these 
wounds  leaving  little  scars,  and  is  not  done  by  those  that  are 
not  superstitious,  who  choose  to  have  them  in  the  leg  or  that 
part  of  the  arm  that  is  concealed.  The  children  or  young  pa- 
tients play  together  all  the  rest  of  the  day,  and  are  in  perfect 
health  until  the  eighth.  Then  the  fever  begins  to  seize  them,  and 
they  keep  their  beds  two  days,  very  seldom  three.  They  have 
rarely  above  twenty  or  thirty  in  their  faces,  which  never  mark ; 
and  in  eight  days'  time  they  are  as  well  as  before  their  illness. 
Where  they  are  wounded  there  remain  running  sores  during 
the  distemper,  which  I  don't  doubt  is  a  great  relief  to  it.  Every 
year  thousands  undergo  this  operation;  and  the  French  ambas- 
sador says  pleasantly :  '  They  take  the  small-pox  here  by  way  of 
diversion,  as  they  take  the  waters  in  other  countries.'  There  is 
no  example  of  any  one  that  has  died  in  it,  and  you  may  believe 
that  I  am  well  satisfied  of  the  safety  of  the  experiment,  since  I 
intend  to  try  it  on  my  dear  little  son. 

"I  am  patriot  enough  to  take  pains  to  bring  this  useful 
invention  into  fashion  in  England;  and  I  should  not  fail  to 
write  to  some  of  our  doctors  very  particularly  about  it,  if  I  knew 
any  of  them  that  I  thought  had  virtue  enough  to  destroy  such  a 
considerable  branch  of  their  revenue  for  the  good  of  mankind. 
But  that  distemper  is  too  beneficial  to  them  not  to  expose  to  all 
their  resentment  the  hardy  wight  that  should  undertake  to  put 
an  end  to  it.  Perhaps,  if  I  live  to  return,  I  may,  however,  have 
courage  to  war  with  them." 

Soon  after  the  date  of  this  letter  the  writer's  son  was 
inoculated  in  Turkey,  and  four  years  later  her  daughter  also, 
being  the  first  subject  inoculated  in  England.  The  practice 
soon  became  popular,  but  several  fatal  cases  among  prominent 
families  brought  it  into  disrepute,  and  for  about  twenty  years 
very  few  inoculations  were  made  in  England.  It  was  revived 
about  the  middle  of  the  century  by  the  founding  of  a  small-pox 
and  inoculation  hospital  in  London.  This  continued  '  in  opera- 
tion until  1822.    The  records  of  this  institution  showed  that  only 


SMALL-POX.  305 

three  in  a  thousand  died  of  the  disease  thus  communicated.  The 
practice  has  now  fallen  into  desuetude,  being  superseded  by  vac- 
cination and  prohibited  by  law  in  England. 

Inoculation  was  introduced  into  this  country  in  1721  by 
Dr.  Zabdiel  Boylston,  of  Boston,  who  had  his  attention  directed 
to  the  practice  by  Cotton  Mather,  the  eminent  divine.1  During 
1721  and  1722,  286  persons  were  inoculated  by  Boylston  and 
others  in  Massachusetts,  and  6  died.  These  fatal  results  ren- 
dered the  practice  unpopular,  and  at  one  time  the  inoculation 
hospital  in  Boston  was  closed  by  order  of  the  Legislature. 
Toward  the  end  of  the  century  an  inoculating  hospital  was  again 
opened  in  that  city. 

Early  in  the  eighteenth  century  inoculation  was  extensively 
practiced  by  Dr.  Adam  Thomson,  of  Maryland,  who  was  instru- 
mental in  spreading  a  knowledge  of  the  practice  throughout 
the  Middle  States.2 

In  China  and  India,  and  perhaps  other  eastern  countries, 
inoculation  was  practiced  at  a  very  early  period. 

The  inoculation  of  variolous  matter,  although  it  mitigated 
to  a  very  great  degree  the  attack  of  small-pox  following,  had 
one  very  serious  objection,  aside  from  the  small  death-rate  which 
was  a  direct  consequence  of  it.  This  was  the  fact  that  inocula- 
tion always  produced  small-pox,  and  thus  assisted  in  propagating 
the  disease ;  for,  however  mild  the  induced  disease  might  be,  the 
inoculated  individual  was  liable  to  communicate  small-pox  to 
others  in  the  most  virulent  form.  Hence,  nothing  short  of  uni- 
versal inoculation,  which  was  manifestly  impracticable,  would 
succeed  in  reducing  the  danger  from  the  disease. 

Vaccination. — It  had  been  noticed  at  various  times  that  a 
pustular  disease' which  sometimes  appears  on  the  udders  of  cows, 
called  cow-pox,  had  not  infrequently  been  transmitted  to  the 
hands  of  the  dairy-maids  and  others  having  much  to   do  with 

■Dr.  John  R.  Quinan  (Md.  Med.  Journ.,  June 23  and  30,  1883)  believes  the  claim  of  Dr. 
Boylston  to  be  the  first  American  inoculator  open  to  question.  The  evidence  presented  is,  how- 
ever, insufficient  to  discredit  the  claim  of  the  Boston  physician. 

a  See  Quinan,  loc.  cit.,  p.  114. 

20 


306  TEXT-BOOK   OF   HYGIENE. 

cows.  In  course  of  time  it  was  also  noticed  that  persons  who 
had  been  thus  attacked  never  suffered  from  small-pox.  This 
protective  power  of  cow-pox  was  known  as  early  as  1713,  and 
in  1774  Benjamin  Jesty,  a  Gloucestershire  farmer,  performed 
vaccination  for  the  first  time  on  record,  inoculating  his  wife  and 
two  sons  with  cow-pox  matter  as  a  protection  against  small-pox. 

It  is  stated  that  when  it  became  known  that  Jesty  had 
vaccinated  his  wife  and  sons,  "his  friends  and  neighbors,  who 
had  hitherto  looked  upon  him  with  respect,  on  account  of  his 
superior  intelligence  and  honorable  character,  began  to  regard 
him  as  an  inhuman  brute,  who  could  dare  to  practice  experi- 
ments upon  his  family,  the  sequel  of  which  would  be,  as  they 
thought,  their  metamorphosis  into  horned  beasts.  Consequently 
the  worthy  farmer  was  hooted  at,  reviled,  and  pelted  whenever 
he  attended  the  markets  in  his  neighborhood."1 

In  1791  a  school-teacher  in  Holstein  also  inoculated  three 
boys  with  the  matter  of  cow-pox,  but  nothing  is  known  of  the 
subsequent  history  of  these  cases. 

Although  the  above  facts  are  clearly  established,  it  is  to 
Edward  Jenner,  a  modest  country  doctor  of  Berkeley,  in  the 
county  of  Gloucester,  England,  that  the  merit  of  demonstrat- 
ing the  protective  power  of  cow-pox  against  small-pox,  and  of 
diffusing  a  knowledge  of  this  fact,  is  due.  Jenner  had  his  atten- 
tion directed  to  the  asserted  protection  conferred  by  cow-pox 
during  the  period  of  his  apprenticeship.  After  a  residence  in 
London  as  a  pupil  of  John  Hunter,  he  returned  to  the  country 
to  practice  his  profession.  About  the  year  1776  he  began 
studying  the  question,  and  gathering  evidence  of  the  protection 
afforded  against  small-pox  by  the  accidental  inoculation  of  cow- 
pox  virus.  For  twenty  years  he  studied  the  subject,  patiently 
awaiting  an  opportunity  to  put  his  belief  to  the  test  of  experi- 
ment. On  the  14th  of  May,  1796,  he  made  his  first  vaccination 
on  a  boy  named  James  Phipps.  Six  weeks  later  he  inoculated 
this  boy  with  variolous  matter,  but  without  success,  no  small- 

1  London  Lancet,  September  13, 1862. 


SMALL-POX.  307 

pox  resulting.  Two  years  later  he  published  his  pamphlet, 
entitled  "  An  Inquiry  into  the  Causes  and  Effects  of  the  Variola 
Vaccinae,  etc.,"  in  which  he  detailed  his  observations  and  experi- 
ments. This  publication  produced  a  great  sensation  in  the 
medical  world,  and,  although  much  opposition  was  at  first 
manifested  toward  his  views,  he  soon  gained  many  adherents. 

Vaccination,  as  the  operation  for  the  inoculation  of  cow-pox 
virus  is  termed,  was  rapidly  introduced  into  all  civilized  countries, 
and  soon  demonstrated  its  good  effects  by  greatly  restricting  the 
prevalence  of  small-pox.  It  is  generally  believed  that  the  first 
one  to  practice  vaccination  in  this  country  was  Dr.  Benjamin 
Waterhouse,  of  Boston,  in  the  summer  of  1 800 ;  but  Dr.  John 
R.  Quinan  has  recently  shown1  that  vaccination  was  introduced 
into  Maryland,  by  Dr.  John  Crawford  and  Dr.  James  Smith,  at 
least  as  early  as  the  date  generally  assigned  for  its  introduction 
into  Massachusetts. 

It  was  believed  by  Dr.  Jenner,  and  was  afterward  conclu- 
sively shown  by  a  number  of  distinguished  experimenters,  that 
vaccinia,  as  the  disease  produced  by  cow-pox  inoculation  was 
called,  was  merely  a  modification  of  small-pox  as  it  existed  in 
the  cow.  Small-pox  virus,  when  inoculated  upon  the  cow, 
produced  cow-pox ;  but  the  latter,  re-inoculated  upon  man, 
produced  cow-pox  (vaccinia),  and  not  small-pox.  Sheep-pock 
and  horse-pock,  or  "  grease,"  are  probably  merely  modifications 
of  the  disease  produced  by  inoculating  small-pox  into  those 
animals. 

When  cow-pox  virus  is  successfully  inoculated  into  the 
human  system — that  is,  when  a  person  is  successfully  vaccinated 
— the  following  local  and  general  symptoms  are  observed : — 

In  the  case  of  a  primary  vaccination,  i.e.,  where  the 
individual  has  not  been  previously  vaccinated  or  attacked  by 
small-pox,  the  point  where  the  vaccination  is  made  shows  no 
particular  change  for  the  first  two  days.  If  the  vaccination  is 
successful,  a  small,  reddish  papule  appears  by  the  third  day, 

1  Quinan,  loc.  cit.,  pp.  118, 131. 


308  TEXT-BOOK   OF   HYGIENE. 

which,  by  the  fifth  or  sixth  day,  has  become  a  distinct  vesicle  of 
a  bluish-white  color,  with  a  raised  edge  and  a  peculiar,  central, 
cup-like  depression  called  the  umbilication.  By  the  eighth  day 
this  vesicle  has  become  plump,  round,  and  pearl-colored,  the 
central  umbilication  being  still  more  marked.  At  this  time  a 
red,  inflamed  circle,  called  the  areola,  appears,  surrounding  the 
vesicle  and  extending  usually  in  a  radius  of  from  \  to  2  inches 
when  fully  developed.  This  inflammatory  ring  is  usually  pretty 
firm,  and  there  is  more  or  less  general  fever  and  often  enlarge- 
ment and  tenderness  of  the  axillary  glands.  After  the  tenth 
day  the  areola  begins  to  fade,  and  the  contents  of  the  vesicle 
dry  into  a  hard,  brownish  crust  or  scab,  which  falls  off  between 
the  twentieth  and  twenty-fourth  days,  leaving  a  punctated  scar, 
which  gradually  becomes  white. 

When  the  vaccinia  has  passed  through  all  of  these  stages, 
especially  if  the  vesicle  filled  with  pearly  lymph,  and  the  areola 
have  been  well  developed,  the  vaccination  may  be  considered  a 
success,  and  the  individual  protected  against  small-pox  for  a 
number  of  years,  if  not  for  life.  Recently  the  doctrine  has  been 
strongly  advocated  that  vaccination  is  not  absolutely  protective 
until  a  subsequent  inoculation  of  vaccine  fails  to  "  take." 
According  to  this  view,  vaccination  should  be  repeated  until  it 
fails  any  longer  to  exhibit  any  local  reaction.  When  this  has 
been  attained  the  individual  may  be  considered  absolutely 
protected  for  life.  Theoretically,  this  view  has  much  in  its 
favor,  but  there  is,  as  yet,  not  sufficient  evidence  to  establish  it 
as  a  law. 

It  may  be  stated  as  an  established  fact  that  vaccination, 
although  carefully  performed  and  successful,  does  not  confer 
absolute  immunity  from  small-pox  for  life.  The  protective 
power  seems  to  wear  out  after  a  time  and  the  individual  then 
again  becomes  susceptible  to  small-pox.  An  attack  of  small- 
pox in  a  vaccinated  individual  is,  however,  nearly  always  much 
milder  than  where  there  had  been  no  vaccination.  There  is  no 
fact  in  the  entire  range  of  medicine  better  established  than  this- 


SMALL-POX.  309 

that  small-pox  in  vaccinated  persons  is  a  much  less  dangerous 
disease  than  typhoid  fever,  while  in  unvaccinated  cases  the 
mortality  ranges  from  30  to  40  per  cent.  An  approximate 
guide  to  the  beneficent  influence  of  vaccination  upon  the 
mortality  from  small-pox  is  furnished  by  a  table  in  Seaton's 
report  on  vaccination.  Before  the  introduction  of  vaccination 
the  mortality  from  small-pox,  per  million  of  inhabitants  of  Eng- 
land, was  nearly  3000  per  year.  After  the  introduction  of  vac- 
cination the  mortality  was  reduced  to  310  per  million  per  year. 

The  most  remarkable  and  convincing  statistical  evidence 
on  the  question  is  given  by  Drs.  Seaton  and  Buchanan,  of 
England.  During  the  small-pox  epidemic  in  London,  in  1863, 
they  examined  over  50,000  school-children,  and  found  among 
every  thousand  without  evidence  of  vaccination  360  with  scars 
of  small-pox,  while  of  every  thousand  presenting  some  evidence 
of  vaccination  only  1.78  had  any  such  traces  of  small-pox  to 
exhibit.1  The  reliability  of  general  mortality  statistics  may  be 
called  in  question — in  some  cases,  with  justice ;  but  the  signifi- 
cance of  these  figures  cannot  be  evaded. 

The  upper  and  outer  surface  of  the  arm  is  usually  chosen 
as  the  point  where  the  virus  is  inserted,  although  any  part  of 
the  body  which  can  be  protected  against  friction,  or  other 
mechanical  irritation,  may  be  selected.  The  method  varies 
slightly  in  the  hands  of  different  vaccinators.  The  two  methods 
most  frequently  in  use  are  scarification  and  erasion.  The 
former  method  has  the  indorsement  of  Mr.  Seaton,  the  high 
English  authority.  The  method  of  erasion — scraping  off  the 
epidermis  until  the  papillary  layer  of  the  skin  is  laid  bare — is 
now  most  frequently  used  in  this  country.  The  best  instrument 
to  use  is  a  clean  thumb-lancet ;  in  default  of  this,  an  ordinary 
sewing-needle  answers  well.  Where  animal  vaccine  is  used, 
the  ivory  slip  or  sharpened  quill  may  also  be  used  with  satis- 
faction to  make  the  scarification  or  erasion.  Whatever  instru- 
ment is  used,  it  should  always  be  kept  perfectly  clean. 

1  Seaton,  "  Vaccination,"  in  Reynolds's  System  of  Medicine,  vol.  i,  p.  291.    Second  edition. 


310  TEXT-BOOK   OF   HYGIENE. 

A  point  of  vital  importance  is  that  which  relates  to  the 
proper  age  at  which  children  should  be  vaccinated.  Ordinarily, 
vaccination  should  be  performed  within  the  first  six  months  of 
life.  In  time  of  danger  from  a  threatened,  or  in  the  presence 
of  an  actual,  epidemic,  infants  may  be  vaccinated  when  only  1 
day  old. 

In  order  to  secure  permanent  protection  against  small-pox, 
re  vaccination  should  be  performed  after  a  certain  interval. 
Some  place  the  period  at  which  this  second  vaccination  should 
be  done  at  five  years,  while  others  allow  a  longer  interval — 
seven,  eight,  or  ten  years.  The  law  of  Prussia  is  that  every 
child  that  has  not  already  had  small-pox  must  be  vaccinated 
within  the  first  year  of  its  life,  and  every  pupil  in  a  public  or 
private  institution  is  to  be  revaccinated  during  the  year  in 
which  his  or  her  twelfth  birthday  occurs. 

This  law  was  passed  in  1874.  Prior  to  this  time  the 
mortality  from  small-pox  was  15  to  20  per  100,000  of  the 
population.  Since  the  law  was  enacted  the  small-pox  mortality 
has  varied  from  0.3  to  3.6  per  100,000.  Not  a  single  death 
from  small-pox  occurred  in  the  German  army  between  1874 
and  1882.1 

A  revaccination,  even  if  successful,  seldom  passes  through 
all  the  typical  stages  of  a  primary  vaccination.  The  vesicle 
rarely  becomes  so  full  and  plump,  and  is  more  frequently  flat 
and  irregular  in  outline.  Swelling  of  the  axillary  glands  and 
other  complications  also  seem  to  be  more  frequent  than  in  cases 
where  the  vaccination  is  done  for  the  first  time. 

The  question  whether  the  lymph  direct  from  the  cow  or 
humanized  lymph  is  the  more  efficient  has  caused  much  dis- 
cussion. The  objections  urged  against  the  use  of  humanized 
virus  are :  first,  that  its  protective  power  has  become  diminished 
by  transmission  through  many  generations ;  second,  that  it  is 
liable  to  transmit  other  diseases,  such  as  syphilis,  tuberculosis, 
scrofula,  etc.;  third,  that  it  is   frequently  difficult  to  obtain  in 

1  Frolieh,  Militar-Medicin,  p.  461. 


SMALL-POX.  311 

sufficient  quantities  in  an  emergency,  such  as  an  actual  or 
threatened  epidemic. 

The  first  objection  is  disproved  by  the  testimony  of  many 
of  the  most  distinguished  medical  men  in  Europe  and  this 
country.  Humanized  vaccine  virus,  when  properly  inoculated, 
seems  to  be  as  completely  protective  against  small-pox  as  that 
taken  direct  from  the  animal.  Among  its  advantages  are,  that 
it  "  takes  "  more  readily  and  runs  through  its  stages  of  develop- 
ment in  a  shorter  time,  and  that  it  will  retain  its  active  proper- 
ties for  a  greater  length  of  time  than  animal  virus.  The 
physician  can  usually  control  the  source  whence  he  obtains  it. 
He  can  watch  over  the  subject  that  furnishes  it  and  reject  that 
which  is  suspicious.  With  humanized  lymph  collected  by  the 
physician  himself  there  can  be  no  doubt  as  to  its  purity  or  age ; 
with  animal  lymph  furnished  by  the  cultivators  of  that  article 
there  can  be  no  certainty  about  either  of  these  important  points. 

That  syphilis  has  been  inoculated  with  humanized  virus 
can  no  longer  be  open  to  doubt.  The  recent  experiment  of 
Dr.  Cory,  of  England,  has  settled  this  question  definitely.  With 
care,  however,  this  sad  accident  can  easily  be  avoided,  and  the 
fact  that  syphilis  has  been  so  rarely  transmitted  by  vaccination 
is  sufficient  evidence  that  the  danger  of  such  infection  is  not 
very  great. 

The  most  serious  objection  against  the  exclusive  use  of 
humanized  lymph  is,  that  in  grave  emergencies,  such  as  a 
rapidly-spreading  epidemic  of  small-pox,  it  is  difficult  to  obtain 
a  sufficient  supply  of  the  lymph. 

Humanized  virus  is  inoculated,  either  in  the  fresh  state, 
i.e.,  the  lymph  is  taken  from  the  vesicle  on  the  seventh  day  and 
inoculated  directly  into  the  arms  of  other  individuals,  or  else  the 
vesicle  is  allowed  to  dry  into  a  crust,  with  which  a  thin  paste  is 
made  by  moistening  with  water  at  the  time  of  vaccination.  The 
readiest  way  of  using  the  crust  is  to  crush  a  small  fragment 
between  two  small  squares  of  glass,  then  moistening  it  with  a 
drop  of  warm  (not  hot)  water,  and  smearing  it  on  the  spot 


312  TEXT-BOOK    OF   HYGIENE. 

where  the  vaccination  is  to  be  made.  With  the  lancet  a 
number  of  cross-scarifications  are  then  made,  and  the  virus  well 
rubbed  in.  Only  so  much  of  the  crust  should  be  moistened  as 
will  be  used  at  the  time.  Particular  care  must  be  taken  not  to 
use  saliva  for  moistening  the  crust.  Aside  from  being  unclean, 
there  is  danger  of  producing  blood-poisoning  by  inoculating 
certain  of  the  oral  secretions.1 

Animal  virus  is  obtained  by  inoculating  a  calf  or  heifer 
with  virus,  either  derived  from  a  case  of  small-pox,  from  another 
case  of  cow-pox,  or  by  re-inoculating  humanized  vaccine  virus 
into  the  animal.  The  vesicles  are  opened  on  the  seventh  day, 
and  ivory  points  or  the  ends  of  quills  coated  with  the  lymph 
and  dried  with  a  gentle  heat. 

In  vaccinating  with  animal  virus,  the  quill  or  ivory  point 
is  first  moistened  with  a  drop  of  water  to  soften  the  adhering 
lymph ;  the  scarification  or  abrasion  of  the  skin  is  then  made 
with  the  lancet,  and  the  virus  rubbed  well  into  the  scarified 
spot. 

In  using  animal  virus  the  successive  stages  of  development 
are  usually  one  or  two  days  later  than  when  humanized  virus 
is  used.  In  the  former  case  the  areola  is  rarely  developed 
before  the  ninth  day. 

Certain  complications  are  likely  to  occur  in  the  course  of 
the  vaccinia,  of  which  the  student  should  be  aware. 

When  the  areola  appears  there  is  usually  more  or  less 
fever.  Sometimes  the  constitutional  manifestations  are  de- 
cidedly marked,  fever  of  a  high  grade  being  not  uncommon. 
In  addition  to  the  glandular  enlargement  and  tenderness,  an 
outbreak  of  roseola  sometimes  comes  on  about  the  ninth  or 
tenth  day.  This  eruption  may  be  mistaken  for  scarlet  fever, 
but  if  it  is  remembered  that  two  infectious  diseases  rarely  co- 
exist in  one  individual  during  their  full  development  this  error 
will  be  avoided.  , 

Erysipelas  involving  the  entire  arm  is  sometimes  observed 

1  See  Sternberg  and  Magnin,  Bacteria,  p.  355.    Second  edition. 


SMALL-POX.  313 

as  a  complication  of  vaccination.  This,  in  nearly  every  case, 
depends  upon  some  depravement  of  the  patient's  constitution, 
innutrition,  bad  sanitary  surroundings,  or,  perhaps,  more  fre- 
quently, chronic  alcoholism.  Individuals  who  are  habitually 
intemperate  in  the  indulgence  of  alcoholic  liquors  are  espe- 
cially unfavorable  subjects  for  vaccination.  The  results  are, 
fortunately,  rarely  serious  to  the  patient. 

Another  inconvenient  complication  of  vaccination  is  the 
formation  of  a  deep,  ill-looking,  sloughing  ulcer  at  the  vacci- 
nated point.  This  has  been,  in  the  author's  experience,  a  much 
more  frequent  concomitant  when  animal  virus  has  been  used  than 
when  humanized  virus  was  resorted  to.  It  should  be  borne  in 
mind  that  a  very  sore  arm,  especially  if  followed  by  the  formation 
of  an  ulcer  or  gangrenous  sore,  may  not  be  protective  against 
small-pox.  Such  a  patient  should  not  be  considered  properly 
vaccinated,  and  must  be  revaccinated  as  soon  as  he  recovers,  or 
immediately  if  there  is  any  danger  of  small-pox  infection. 

Children  with  eczematous  eruptions,  however,  localized 
upon  any  portion  of  the  body,  should  not  be  vaccinated  until 
the  eruption  is  first  cured,  except  in  times  of  danger  from 
small-pox.  The  eczema  will  be  almost  certainly  rendered  worse 
in  consequence  of  the  general  hypersemia  accompanying  the 
febrile  reaction,  and  the  physician  who  performs  the  vaccination 
will  be  blamed  for  causing  the  skin  disease. 

The  author  has  placed  on  record1  two  cases  of  general 
psoriasis  following  vaccination,  and  other  cases  have  been  since 
reported.  Urticaria  and  exudative  erythema  have  also  been 
repeatedly  observed. 

As  before  stated,  syphilis  may  be  communicated  to  the 
vaccinee  by  vaccine  virus  obtained  from  a  syphilitic  subject,  but 
this  accident  is  infrequent.  There  can  be  little  doubt  that  some 
of  the  cases  reported  as  "  vaccinal  syphilis  "  are  cases  of  tardy 
hereditary  syphilis,  lighted  up  by  the  general  systemic  disturb- 
ance following  vaccination. 

1  Journal  Cutaneous  and  Venous  Diseases,  vol.  i,  No.  1,  p.  11. 


314  TEXT-BOOK   OF   HYGIENE. 

Next  in  importance  to  vaccination  in  the  prophylaxis  of 
small-pox  is  prompt  isolation  of  the  sick.  No  one  bnt  the 
medical  and  other  attendants  of  the  sick  should  be  allowed  to 
come  in  contact  with  them.  All  attendants  and  other  persons 
exposed  to  the  infection  should,  of  course,  be  promptly  vacci- 
nated, unless  this  has  been  successfully  done  within  the  previous 
year  or  two. 

Disinfection  of  all  discharges  from  the  patient  and  of  the 
room  and  its  contents,  after  the  patient  has  recovered  or  died, 
must  be  practiced.  The  best  disinfectants  in  small-pox  are 
bichloride  of  mercury,  free  chlorine,  and  sulphurous  acid. 

When  it  is  learned  that  a  person  has  small-pox,  if  he  is  not 
removed  to  a  special  hospital,  a  room  should  be  prepared  for  his 
occupancy.  The  carpets  should  be  taken  up  and  the  floor  kept 
clean.  Window-curtains  and  unnecessary  furniture  and  drapery 
should  be  removed  from  the  room.  After  recovery  of  the 
patient  the  bed-clothing  must  be  thoroughly  disinfected  with 
steam  or  sulphurous  acid,  or  destroyed  by  fire.  The  individual 
himself  should  not  be  allowed  to  mingle  with  healthy  persons 
until  all  danger  of  infection  is  passed  and  the  surface  of  his 
body  has  been  thoroughly  disinfected. 

ASIATIC   CHOLERA. 

A  disease  which  causes  the  death  of  three-fourths  of  a 
million  of  human  beings  in  the  country  where  it  is  endemic, 
within  the  space  of  five  years,  and  which  makes  periodical  ex- 
cursions, spreading  over  nearly  the  entire  inhabited  globe  with 
destructive  violence,  must  surely  command  the  interested  atten- 
tion of  every  intelligent  person. 

Asiatic  cholera  is  an  endemic  disease  of  India,  where  it 
probably  originated  centuries  ago.  Some  authors  claim  to  have 
found  satisfactory  evidence  of  its  existence  in  the  writings  of  the 
classical  authors  of  India  and  Greece  at  a  period  as  early  as  the 
second  century  of  the  Christian  era.  The  evidence  is,  however, 
not  beyond  question.     In  the   sixteenth  and  seventeenth  cen- 


ASIATIC    CHOLERA.  315 

turies  European  travelers  in  the  East  gave  pretty  exact  accounts 
of  the  disease.  One  of  the  most  definite  of  these  was  given  by 
Gaspar  Correa,  an  officer  in  Vasco  da  Gama's  expedition  to 
Calicut.  He  states  that  Zamorin,  the  chief  of  Calicut,  lost 
20,000  of  his  troops  by  the  disease.  A  still  more  definite  and 
the  first  trustworthy  account  is  that  of  Sonnerat,  a  French  trav- 
eler. He  describes  a  pestilence  having  all  the  characters  now 
recognized  as  belonging  to  Asiatic  cholera,  which  prevailed  in 
the  neighborhood  of  Pondicherry  and  the  Coromandel  coast  in 
1768  and  1769,  and  which  carried  off  60,000  of  those  attacked 
by  it  within  a  year.  Dr.  Macpherson,  in  his  "  History  of  Cholera," 
gives  numerous  references  which  indisputably  establish  the  en- 
demic existence  of  the  disease  in  India  anterior  to  the  present 
century. 

Being  endemically  prevalent  over  a  greater  or  less  area  of 
India  for  many  years,  cholera  finally,  in  1817,  crossed  the 
boundaries  of  that  country,  and,  advancing  in  a  southeasterly 
direction,  invaded  Ceylon  and  the  Sunda  Islands  in  1818.  In  a 
westerly  direction  the  disease  was  carried  to  the  islands  of 
Mauritius  and  Reunion,  and  reached  the  African  coast  in  1820. 
During  this  year  it  also  traveled  northeasterly,  devastating  the 
Chinese  Empire  for  the  two  following  years,  reaching  Nagasaki, 
in  Japan,  in  1822. 

In  1821  the  disease  spread  from  India  in  a  westerly  direc- 
tion, extending  along  the  east  coast  of  Arabia  to  the  border  of 
Mesopotamia  and  Persia.  In  the  spring  of  1822  it  began  with 
renewed  violence,  following  the  river  Tigris  to  Kurdistan,  and, 
extending  farther  in  a  westerly  direction,  reached  the  Mediter- 
ranean coast  of  Syria.  In  the  following  year,  1823,  it  extended 
from  Persia  into  Asiatic  Russia,  reaching  Astrachan  on  the 
European  border  in  September,  but  dying  out  nearly  every- 
where beyond  the  borders  of  India  during  the  ensuing  winter. 

In  1826  cholera  again  advanced  from  India,  reaching 
Orenburg  in  Russia  in  1829,  and  in  the  following  winter 
appeared  in  St.  Petersburg.     Extending  to  the  north  and  south, 


316  TEXT-BOOK   OF    HYGIENE. 

it  invaded  Finland  and  Poland  the  same  year.  From  Persia  the 
disease  spread  to  Egypt  and  Palestine  in  1830-31. 

From  Russia  the  pestilence  invaded  Germany  in  1831, 
passing  thence  in  1832  into  France,  the  British  Isles,  Belgium, 
the  Netherlands,  Norway,  and  Sweden.  In  the  latter  year 
cholera  crossed  the  Atlantic  Ocean  for  the  first  time,  being  car- 
ried to  Canada  by  emigrants  from  Ireland,  and  spreading  thence 
to  the  United  States  by  way  of  Detroit.  In  the  same  year  it 
was  imported  into  New  York  by  emigrants,  and  rapidly  spread 
along  the  Atlantic  coast.  During  the  winter  of  1832  it  appeared 
at  New  Orleans,  and  passed  thence  up  the  Mississippi  Valley. 
Extending  into  the  Indian  country,  causing  sad  havoc  among 
the  aborigines,  it  advanced  westward  until  its  further  progress 
was  stayed  by  the  shores  of  the  Pacific  Ocean.  In  1834  it 
re-appeared  on  the  east  coast  of  the  United  States,  but  did  not 
gain  much  headway,  and  in  the  following  year  New  Orleans  was 
again  invaded  by  way  of  Cuba.  It  was  imported  into  Mexico  in 
1833.  In  1835  it  appeared  for  the  first  time  in  South  America, 
being  restricted,  however,  to  a  mild  epidemic  on  the  Guiana  coast. 

While  the  pestilence  was  advancing  in  the  Western  Hemi- 
sphere, it  also  spread  throughout  Southern  Europe,  invading,  in 
turn,  Portugal,  Spain,  and  Italy. 

Extending  in  an  easterly  direction  from  India,  the  disease 
reached  China  and  Japan  in  1830-31 ;  westwardly,  Africa 
was  invaded  in  1834,  and  ravaged  by  the  epidemic  during  the 
following  three  years. 

This  second  extensive  outbreak  of  cholera  ended  in  1837, 
disappearing  at  all  points  beyond  the  borders  of  India.  In 
1846  the  disease  again  advanced  beyond  its  natural  confines, 
reaching  Europe,  by  way  of  Turkey,  in  1848.  In  the  autumn 
of  this  year  it  also  appeared  in  Great  Britain,  Belgium,  the 
Netherlands,  Sweden,  and  the  United  States,  entering  by  way  of 
New  York  and  New  Orleans.  In  the  succeeding  two  years  the 
entire  extent  of  country  east  of  the  Rocky  Mountains  was  in- 
vaded.   During  1851  and  1852  the  disease  was  frequently  im- 


ASIATIC    CHOLERA.  317 

ported  by  emigrants,  who  were  annually  arriving  in  great  num- 
bers from  the  various  infected  countries  of  Europe.  In  1853 
and  1854,  cholera  again  prevailed  extensively  in  this  country, 
being,  however,  traceable  to  renewed  importation  of  infected 
material  from  abroad.  In  the  following  two  years  it  also  broke 
out  in  numerous  South  American  States,  where  it  prevailed  at 
intervals  until  1863. 

Hardly  had  this  third  great  pandemic  come  to  an  end 
before  the  disease  again  advanced  from  the  Ganges,  spreading 
throughout  India,  and  extending  to  China,  Japan,  and  the  East 
India  Archipelago  during  the  years  1863  to  1865.  In  the  latter 
year  it  reached  Europe  by  way  of  Malta  and  Marseilles.  It 
rapidly  spread  over  the  Continent,  and  in  1866  was  imported  into 
this  country  by  way  of  Halifax,  New  York,  and  New  Orleans. 
This  epidemic  prevailed  extensively  in  the  Western  States,  but 
produced  only  slight  ravages  on  the  Atlantic  coast,  being  kept 
in  check  by  appropriate  sanitary  measures.  In  the  same  year 
(1866)  the  disease  was  also  carried  to  South  America,  and  in- 
vaded, for  the  first  time,  the  States  bordering  on  the  Rio  de  la 
Plata  and  the  Pacific  coast  of  the  Continent. 

While  the  epidemic  was  thus  advancing  westward  from  its 
home  in  India,  it  was  at  the  same  time  spreading  northwardly 
over  the  entire  western  part  of  Asia,  and  in  a  southeasterly 
direction  over  Northern  Africa.  In  the  latter  continent  it  pre- 
vailed from  1865  to  1869. 

Cholera  never  entirely  disappeared  in  Russia  during  the 
latter  half  of  the  sixth  decade,  and  in  1870  it  again  broke  out 
with  violence,  carrying  off  a  quarter  of  a  million  of  the  inhabi- 
tants before  dying  out  in  1873.  It  spread  from  Russia  into 
Germany  and  France,  and  was  imported,  in  1873,  into  this 
country,  entering  by  way  of  New  Orleans  and  extending  up 
the  Mississippi  Valley.  None  of  the  Atlantic-coast  cities  suf- 
fered from  the  epidemic  in  1873,  and  since  that  year  the  United 
States  have  been  entirely  free  from  the  disease,  with  the  excep- 
tion of  a  few  imported  cases  hi  New  York  Harbor  in  1887. 


318  TEXT-BOOK   OF   HYGIENE. 

In  June,  1883,  a  new  epidemic  of  cholera  broke  out  m 
Egypt,  where  it  raged  with  great  violence.  The  disease  first 
appeared  in  Damietta,  near  the  outlet  of  the  Suez  CartaL  It 
was  unquestionably  imported  from  India,  probably  Bombay, 
where  it  prevailed  as  early  as  the  month  of  May.  At  the  time 
of  the  outbreak  in  Damietta  that  city  was  overcrowded  with 
people  who  had  come  to  attend  a  great  religious  fair  and  festival. 
It  has  been  proven  that  pilgrims  from  Bombay  were  among  the 
attendants  at  this  fair.  The  epidemic  came  to  an  end  in  Egypt 
in  the  autumn  of  1883.  In  the  same  year  (1883)  a  small  out- 
break occurred  in  Marseilles,  but  intelligence  of  it  was  carefully 
suppressed  by  the  authorities.  The  disease  does  not  seem  to 
have  spread  from  this  centre,  but  in  June  of  the  following  year 
cholera  broke  out  in  Toulon,  having  probably  been  imported  in 
a  transport  ship  returning  from  Tonquin.  This  outbreak  was 
very  violent  and  rapidly  spread  throughout  Southern  France, 
Italy,  and  Spain.  After  apparently  dying  out  during  the  winter, 
it  re-appeared  in  the  spring  of  1885  with  renewed  violence.  The 
total  number  of  cases  in  Spain  alone  in  the  latter  year  was  over 
one-third  of  a  million,  with  nearly  120,000  deaths. 

In  the  summer  of  1885  cholera  also  broke  out  in  a  viru- 
lent form  in  Japan,  and,  after  a  cessation  during  the  folloAving 
winter,  recurred  with  increased  fatality  in  1886.  In  the  latter 
year  there  were  over  100,000  deaths  from  the  disease  in  that 
country. 

During  1886  and  1887  cholera  continued  in  Southeastern 
Italy  and  in  the  Austrian  dominions  at  the  head  of  the  Adriatic. 
A  few  cases  occurred  in  France  and  Germany,  but  by  stringent 
sanitary  measures  an  epidemic  was  averted. 

In  November,  1886,  cholera  was  carried  to  South  America 
in  an  Italian  ship,  the  "Perseo,"  bound  from  Genoa  to  Buenos 
Ayres.  The  disease  rapidly  spread  in  the  Argentine  Kepublic, 
and,  crossing  the  Andean  range,  invaded  the  Pacific  coast  of  the 
South  American  continent  for  the  second  time,  reaching  Chili 
and  Bolivia  and  threatening  Peru  and  Brazil.     In  Chili  alone 


ASIATIC    CHOLERA.  319 

there  were  over  10,000  deaths  in  the  first  six  months  of  1887. 
The  further  progress  of  the  epidemic  was  arrested  and  the  entire 
Western  Hemisphere  is  now  free  from  the  disease. 

From  July  to  December,  1889,  cholera  prevailed  with  con- 
siderable virulence  in  Mesopotamia.  This  epidemic  seems,  at 
the  time  of  writing  (February  1,  1890),  to  be  at  an  end. 

This  brief  historical  sketch  of  all  the  epidemics  of  cholera 
observed  beyond  the  borders  of  India  demonstrates  several 
facts:  first,  that  the  home  or  breeding-place  of  cholera  is  in 
India,  especially  the  delta  of  the  Ganges,  whence  it  spreads  at 
intervals  throughout  the  world;  second,  that  it  always  advances 
along  the  lines  of  travel  of  large  bodies  of  human  beings ;  and, 
third,  that  it  advances,  by  preference,  along  water-routes.  The 
latter  is  particularly  noticeable  in  the  behavior  of  cholera  epi- 
demics in  this  country.  When  it  has  spread  from  an  Atlantic 
port,  it  has,  generally,  been  to  other  places  having  water  com- 
munication with  that  port.  Exceptions  undoubtedly  occur,  but 
the  rule  is  a  general  one.  The  disease  seems  to  spread  with 
difficulty  along  the  lines  of  railroad.  When  the  disease  has 
extended  from  New  Orleans  it  has  always  been  up  the  Mississippi 
Valley,  expending  its  violence  upon  the  river  cities — Vicksburg, 
Memphis,  St.  Louis,  and  Cincinnati. 

Several  factors  must  concur  before  there  can  be  an  epidemic 
of  cholera.  These  are :  first,  the  cholera  poison ;  second,  cer- 
tain local  conditions  of  air,  soil,  or  water ;  and,  third,  individual 
predisposition.  Without  a  concurrence  of  all  these  conditions 
no  outbreak  can  occur.  If,  by  any  means,  the  co-existence  of 
these  three  conditions  can  be  prevented,  cholera  can  be  averted. 
The  following  are  facts  bearing  upon  this  question :  Cholera  is 
communicated  through  the  agency  of  a  specific  poison.  This 
does  not  admit  of  doubt.  The  poison  may  be  either  an  organic 
germ,  or  of  an  inorganic,  particulate,  or  gaseous  nature.  The 
recent  researches  of  Dr.  Robert  Koch,  of  Germany,  indicate 
that  a  micro-organism  found  in  the  intestinal  discharges  of  cholera 
patients  and  in  the  bodies  of  those  dead  with  the  disease  is  the 


320  TEXT-BOOK   OF   HYGIENE. 

active  agent  in  propagating  the  malady.  This  organism,  named 
by  Koch  the  "comma  bacillus,"  from  its  general  resemblance 
to  a  comma,  was  first  discovered  by  this  eminent  pathologist  in 
the  intestinal  contents  of  cholera  corpses  in  Egypt  in  1883,  and 
in  the  following  year  more  thoroughly  studied  in  Calcutta, 
whither  he  had  been  sent  by  the  German  government  to  pursue 
his  investigations.  It  has  been  demonstrated  that  this  germ  is 
always  present  in  the  discharges  of  cholera  patients,  and  up  to 
this  time  it  has  not  been  found  in  any  other  disease.  Experi- 
ments upon  animals  have  also  shown  that  cholera  can  be  pro- 
duced in  the  latter  by  introducing  the  germ  into  their  bodies  in 
various  ways.  The  demonstration  of  the  bacterial  nature  of 
cholera  seems  to  be  complete. 

While  cholera  cannot  be  regarded  as  personally  contagious 
in  the  same  sense  or  in  the  same  degree  as  small-pox,  there  can 
be  no  doubt  that  it  is  spread  only  by  the  poison  from  other  cases 
of  the  disease.  The  regularity  of  its  march  along  routes  by 
which  the  intercourse  of  human  beings  takes  place,  and  always 
in  connection  with  other  cases  of  cholera,  proves  this.  There  is 
no  undoubted  case  on  record  where  genuine  cholera  has  been 
spontaneously  developed  outside  of  India. 

That  certain  local  geological  and  perhaps  meteorological 
conditions  are  necessary  for  the  propagation  or  virulence  of  the 
poison  of  cholera  is  beyond  dispute.  Outbreaks  usually  take 
place  during  the  summer  or  autumn,  and  nearly  always  partly 
or  entirely  die  out  during  cold  weather.  Further,  in  nearly  all 
epidemics,  certain  cities  or  towns,  or  portions  of  a  town,  into 
which  persons  sick  with  cholera  are  brought,  and  where  the 
poison  of  the  disease  is  thus  imported,  remain  exempt  from  the 
effects  of  the  epidemic.  The  inference  to  be  drawn  from  this 
fact  is  that  in  such  localities  the  local  conditions  are  unfavorable 
to  the  development  of  the  poisonous  germ,  and  it  becomes  inert. 

In  India  all  the  local  conditions  favorable  to  the  propagation 
of  the  cholera-germ  are  found.  The  filthy  personal  habits  of 
the  people,  the  overcrowding,  the  intense  heat,  the  lack  of  suf- 


ASIATIC   CHOLERA.  321 

ficient,  appropriate,  or  properly-prepared  food,  and  the  exten- 
sive pollution  of  the  water-supply,  all  combine  to  produce  the 
necessary  conditions  of  development  of  the  cause  of  cholera. 
These  conditions,  doubtless,  to  a  considerable  extent,  give  rise 
to  that  depression  of  the  system  which  seems  necessary  to  con- 
stitute the  individual  predisposition  to  become  infected. 

Given,  then,  at  any  place,  a  number  of  persons  of  a  lowered 
degree  of  vitality, — that  is  to  say,  persons  not  capable  of  resisting 
unfavorable  influences  upon  their  health  under  unfavoring  con- 
ditions ;  given  conditions  of  climate,  water,  and  soil  more  or  less 
similar  to  those  existing  in  India :  only  the  introduction  of  the 
third  factor,  the  cholera  poison,  is  needed  to  cause  an  outbreak. 
In  many  cities  of  this  country  and  Europe,  as  proven  by  the 
most  recent  epidemics  in  Toulon,  Marseilles,  Naples,  and  other 
cities  of  Italy  and  Spain,  the  conditions  are  present  which  would 
furnish  the  most  favorable  breeding-place  for  the  cholera-germ 
if  introduced. 

The  dejections  and  vomited  matters  of  cholera  patients  con- 
tain the  active  agent  which  produces  the  disease.  The  contagi- 
ous principle  contained  in  these  excretions,  probably  the  cholera- 
germ  or  "comma  bacillus"  discovered  by  Koch,  may  gain  an 
entrance  into  the  body  through  the  drinking-water  or  through 
infected  air.  Probably  both  modes  are  equally  competent  chan- 
nels of  infection.  The  prevailing  theory  islthat  pollution  of  the 
drinking-water  is  the  most  frequent  source  of  the  rapid  spread 
of  the  disease.  A  very  striking  instance  of  this  occurred  in 
London  during  the  epidemic  of  1854,  which  has  already  been 
referred  to.1 

Another  striking  instance  of  the  communication  of  cholera 
by  polluted  water  has  been  reported  by  Mr.  John  Simon,  long  the 
chief  medical  officer  of  the  English  "Local  Government  Board." 
The  facts  are  as  follow :  The  Lambeth  Water  Company  drew 
its  supply  from  the  Thames,  at  Ditton,  above  the  influence  of 
the  London  sewage  and  the  tidal  flux.     The  Southwark  and 

1  See  ante,  page  64. 
21 


322  TEXT-BOOK   OF   HYGIENE. 

Vauxhall  Company  drew  its  supply  from  the  river  near  Vauxhall 
and  Chelsea.  The  water  of  the  Lambeth  Company  was  toler- 
ably pure,  and  that  of  the  Southwark  and  Vauxhall  Company 
was  very  impure.  The  water  of  both  companies  was  distributed 
in  the  same  district  at  the  same  time  and  among  the  same  class 
of  people,  the  pipes  of  the  two  companies  being  laid  pretty 
evenly  in  the  same  areas,  in  many  places  running  side  by  side 
in  the  same  streets,  and  the  houses  supplied  being  pretty  equally 
distributed.  The  deaths  from  cholera  in  the  houses  supplied  by 
the  Lambeth  Company  were  at  the  rate  of  37,  and  in  the  houses 
supplied  by  the  Southwark  and  Vauxhall  Company  at  the  rate 
of  130,  to  every  10,000  persons  living.  It  appears,  therefore, 
that  of  the  drinkers  of  the  foul  water  about  three  and  a  half 
times  as  many  as  those  who  drank  the  pure  water  died  of  cholera. 

But  the  spread  of  cholera  cannot  always  be  referred  to  pol- 
lution of  the  drinking-water.  In  many  epidemics  no  relation 
can  be  shown  to  exist  between  the  spread  of  the  disease  and  im- 
pure water.  Professor  von  Pettenkofer,  of  Munich,  has  shown, 
by  a  number  of  carefully-conducted  observations,  that  the  prop- 
agation of  cholera  often  bears  a  very  direct  relation  to  changes 
in  the  stage  of  the  subsoil-  or  ground-  water.  This  does  not 
mean  that  the  subsoil-water  is  directly  or  necessarily  the  agent 
for  the  spread  of  the  disease,  but  that  its  stage,  or  variability, — 
now  high,  now  low, — may  be  considered  as  an  index  of  certain 
processes  going  on  in  the  soil  which  are  intimately  connected 
with  the  propagation  of  cholera  as  well  as  of  certain  other  in- 
fectious diseases,  chief  among  which  is  typhoid  fever.  The 
relations  between  the  ground-water  level  and  cholera  outbreaks 
in  India  and  various  cities  in  Europe  and  America  give  strong 
support  to  the  views  of  von  Pettenkofer.1 

In  addition  to  the  influence  of  the  ground-water  oscillations 
and  polluted  drinking-water  in  spreading  the  cholera-poison, 
must  be  mentioned  articles  of  food  contaminated  with  the  in- 
fectious matter  of  the  disease.     It  is  also  no  longer  open  to 

1  See  page  130. 


ASIATIC    CHOLERA.  323 

question  that  persons  may  become  infected  by  handling  the 
clothing  and  bedding  of  cholera  patients.  Laundresses  are  in 
special  danger  from  this  source.  Physicians  and  nurses  have, 
not  rarely,  been  attacked  under  circumstances  which  pointed 
strongly  to  personal  contagion  as  one  of  the  sources  of  the  disea.se. 

The  prophylaxis  against  cholera  comprises  such  measures 
as  will  prevent  the  admission  of  the  cholera-poison  into  a  com- 
munity, arrest  the  development  of  the  poison  after  its  introduc- 
tion, and  reduce  the  individual  susceptibility  to  attack. 

It  is  evident  from  the  foregoing  that  if  the  introduction  of 
the  cholera-poison  could  be  prevented  no  outbreak  of  the  dis- 
ease could  occur.  With  this  in  view,  some  have  urged  the  en- 
forcement of  a  strict  policy  of  non-intercourse  with  infected 
localities.  But  at  the  present  day  few  sanitarians  advocate  these 
extreme  measures.  A  modified  system  of  restricted  intercourse 
is  supported  by  many  authorities,  who  claim  that  by  the  adoption 
of  a  thorough  system  of  maritime  inspection,  disinfection,  and 
observation — a  rational  quarantine,  in  fact — the  poison  can  be 
rendered  ineffective  or  its  entrace  into  a  commmunity  prevented. 

The  best  authorities,  however,  think  that  it  is  not  only 
easier,  but  far  more  effective  to  place  the  threatened  locality  in 
such  a  sanitary  condition  that  the  development  of  the  cholera- 
poison  cannot  take  place.  The  contrast  between  the  effective- 
ness of  quarantine  and  local  sanitation  as  safeguards  against 
cholera  has  been  well  expressed  by  von  Pettenkofer,  who  com- 
pares cholera  epidemics  to  powder  explosions.  The  virus  of 
cholera,  he  says,  is  the  spark  that  evades  the  strictest  quaran- 
tine ;  the  powder  is  the  ensemble  of  local  conditions  which  pre- 
dispose to  the  outbreak.  "  It  is  wiser,  therefore,  to  seek  out  and 
remove  the  powder  than  to  run  after  and  try  to  extinguish  each 
individual  spark  before  it  drops  upon  a  mass  of  powder,  and, 
igniting  it,  causes  an  explosion  which  blows  us  into  the  air  with 
our  extinguishers  in  our  hands." 

The  measures  of  local  sanitation  to  be  enforced  are  such 
as  will  secure  cleanliness  of  person,  of  habitation  and  surround- 


324  TEXT-BOOK   OF   HYGIENE. 

ings,  of  air,  of  water,  and  of  soil.  Pollution  of  the  soil  should 
be  especially  guarded  against,  for  a  polluted  soil  means  impure 
air  and  water,  and  these  mean,  if  not  an  infectious  disease, 
at  least  a  heightened  receptivity  to  its  influence.  The  quality 
of  the  drinking-water  used  must  be  above  suspicion  of  con- 
tamination by  the  poison.  Unless  the  latter  can  be  positively 
excluded  all  drinking-water  should  first  be  boiled.  It  may  then 
be  cooled  by  pure  ice.  Filtering  the  water  may  not  remove  the 
poison. 

The  individual  predisposition  to  cholera  is  best  guarded 
against  by  keeping  the  body  clean  and  well  nourished,  and  the 
mind  free  from  worry.  Underfeeding,  anxiety,  overwork,  ex- 
posure to  extremes  of  temperature,  intemperance  in  eating  and 
drinking  should  all  be  avoided,  as  they  tend  to  reduce  the  re- 
sistance of  the  system  to  the  influence  of  the  morbid  poison. 

Certain  measures  of  personal  prophylaxis  which  have 
proven  useful  heretofore  should  be  adopted  wherever  cholera 
prevails.  One  of  the  best  of  these  is  the  use  of  sulphuric-acid 
lemonade  as  a  drink.  Ten  to  15  drops  of  dilute  sulphuric  acid 
in  a  glass  of  water,  sweetened  with  sugar,  may  be  drunk  instead 
of  water.  Experience  with  it  during  the  epidemic  of  1866  has 
demonstrated  its  great  value  as  a  preventive  of  cholera.  The 
later  researches  of  Koch  have  also  shown  that  the  "comma 
bacillus,"  or  spirillum,  cannot  live  in  acid  solutions.  Hence, 
it  is  probable  that  if  the  contents  of  the  stomacli  were  always 
kept  acid  no  infection  could  occur  through  absorption  from  the 
stomach. 

A  painless  diarrhoea,  called  cholerine,  attacks  many  persons 
during  cholera  epidemics.  This  disorder  is  easily  curable  if 
promptly  attended  to,  but  if  allowed  to  run  on  it  may  develop 
into  a  malignant  attack  of  cholera. 

Among  the  means  of  securing  prompt  treatment  of  the 
poorer  classes  in  times  of  epidemics  is  the  establishment  of 
numerous  public  dispensaries,  where  medical  aid  can  always  be 
obtained.      The    establishment   of   such   dispensaries   and,   if 


ASIATIC   CHOLERA.  325 

possible,  of  temporary  hospitals  in  the  crowded  portions  of 
cities  is  a  very  important  part  of  the  prophylactic  treatment. 

Inasmuch  as  it  seems  definitely  established  that  the  dis- 
charges from  the  stomach  and  intestines  are  the  active  agents  in 
propagating  the  disease,  the  immediate  disinfection  of  such  dis- 
charges is  vitally  important.  The  stools  and  vomited  matters 
must  be  rendered  innocuous  by  germicidal  agents,  such  as  mer- 
curic chloride,  carbolic  acid,  or  chloride  of  lime. 

Clothing  and  bedding  should  be  disinfected  with  super- 
heated steam,  thorough  boiling,  or  fumigation  with  sulphur 
dioxide  or  chlorine.  Infected  articles  of  this  kind  should  not 
be  sent  to  a  laundry  until  they  have  been  thoroughly  disinfected 
by  one  of  the  above-mentioned  means. 

Apartments  which  have  been  occupied  by  cholera  patients 
should  be  thoroughly  fumigated,  before  being  re-occupied,  with 
burning  sulphur,  and  afterward  freely  exposed  to  the  air  by 
opening  doors  and  windows.  The  walls  may  also  be  washed 
with  a  solution  of  mercuric  chloride. 

The  most  efficient  disinfectant  is  mercuric  chloride  in  the 
proportion  of  1  part  in  2000  of  the  material  to  be  disinfected. 
The  readiest  way  of  securing  disinfection  with  this  agent  is  to 
add  a  solution  of  1  to  1000  to  an  equal  proportion  of  the  dis- 
charges to  be  rendered  innocuous.  The  mercuric  chloride  acts 
slowly,  and  hence  the  infected  material  should  be  exposed  to  the 
action  of  the  disinfecting  agent  for  at  least  two  hours  before  it 
can  safely  be  thrown  into  sewers  or  cess-pools. 

There  are  several  serious  objections  to  the  indiscriminate  use 
of  mercuric  chloride  by  the  public  as  a  disinfectant.  In  the 
first  place,  it  is  intensely  poisonous,  and  its  perfectly  transparent 
and  inodorous  solution  might  readily  be  accidentally  drunk  and 
cause  fatal  results.  To  reduce  this  danger,  the  Committee  on 
Disinfectants  of  the  American  Public  Health  Association  recom- 
mended the  addition  of  permanganate  of  potash  or  of  sulphate 
of  copper  (blue  vitriol)  to  color  the  solution.  Another  serious 
objection  to  mercuric  chloride  is  that  it  cannot  be  used  where 


326  TEXT-BOOK   OF  HYGIENE. 

the  disinfected  material  must  pass  through  lead  pipe,  as  this  is 
rapidly  corroded  by  the  sublimate.  In  many  water-closets  it  can 
therefore  not  be  used. 

Chloride  of  lime  (bleaching-powder)  has  been  found  to  be 
a  very  rapid  and  efficient  disinfectant,  as  well  as  a  deodorizer ; 
but  the  chlorine,  upon  which  its  effectiveness  depends,  is  often 
so  deficient  in  proportion,  and  the  compound  so  readily  deterio- 
rates that,  unless  a  preparation  can  be  obtained  that  contains  at 
least  25  per  cent,  of  available  chlorine,  it  may  prove  injurious 
by  causing  a  false  sense  of  security.  A  trustworthy  preparation 
may  be  dissolved  in  water,  when  required,  in  the  proportion  of 
1  to  100.  An  objection  to  its  use  is  the  pungent  odor  of  chlorine, 
which  is  very  offensive  to  many  persons. 

Dr.  Koch  recommends  carbolic  acid,  which  he  has  shown 
will  kill  the  "  comma  bacilli  "in  a  dilution  of  1  to  20  of  water. 
The  ordinary  preparations  of  carbolic  acid  sold  as  disinfectants 
are,  however,  not  to  be  relied  on,  many  of  them  not  containing 
more  than  2  per  cent,  of  the  acid.  Further  dilution  of  these 
agents  would  altogether  destroy  their  disinfecting  power.  The 
purer  article  is,  on  the  other  hand,  too  expensive  to  be  used  as 
a  disinfectant. 

Little's  soluble  phenyle  is  an  efficient  disinfectant  in  the 
proportion  of  2  per  cent.  (1  to  50).  It  is  furnished  of  uniform 
strength,  is  moderately  cheap,  non-poisonous,  and  readily 
miscible  with  water.  In  addition  to  its  disinfecting  power,  it  is 
also  an  excellent  deodorizer,  promptly  removing  all  odors  of 
decomposition  and  putrefaction.  Its  only  objection  is  a  rather 
pungent  though  not  unpleasant  odor,  which  somewhat  resembles 
creasote. 

In  the  very  beginning  of  an  epidemic,  prompt  isolation  of 
the  sick  and  thorough  disinfection  of  the  surroundings  of  the 
patient  may  check  the  spread  of  the  disease.  Much  cannot  be 
expected  from  these  measures,  however,  unless  the  local  sanitary 
conditions  are  such  as  offer  a  hindrance  to  the  development  of  the 
cholera-poison.    It  is  plain,  therefore,  that  prophylactic  measures 


RELAPSING   FEVER.  327 

against  cholera,  to  be  effective,  must  be  brought  into  requisition 
before  the  epidemic  has  begun.  After  the  outbreak  of  the 
disease  it  may  be  too  late  to  put  the  threatened  locality  in  a 
good  sanitary  condition.  It  is  of  the  highest  importance  that 
preventive  measures  be  enforced  early. 

RELAPSING   FEVER. 

Relapsing  fever  was  first  clearly  described  by  Dr.  John 
Rutty,  in  his  "  Chronological  History  of  the  Weather,  Seasons, 
and  Diseases  of  Dublin  from  1725  to  1765."  x  Near  the  end  of  the 
last  and  in  the  first  half  of  the  present  centuries  relapsing  fever 
was  frequently  met  with  in  an  epidemic  form  in  Ireland  and 
Scotland.  In  1847  the  disease  invaded  a  number  of  the  larger 
cities  of  England.  From  1868  to  1873  it  prevailed  extensively 
in  England  and  Scotland.  On  the  continent  of  Europe  it  was 
first  observed  in  Russia  in  1833.  In  Germany  it  was  not 
recognized  as  a  distinct  disease  until  1847,  but  did  not  prevail 
epidemically  until  1868.  Since  then  it  has  often  been  observed 
in  that  country. 

Relapsing  fever  is  very  prevalent  in  India,  where  it  was 
first  observed  in  1856  by  Sutherland.  In  China  and  in  the 
countries  of  Africa  bordering  on  the  Red  Sea  the  disease  has 
been  recognized  by  observers. 

In  the  United  States  it  was  first  observed  among  emigrants 
in  Philadelphia  in  1844,  and  again  in  1869.  It  was  conveyed 
to  other  places,  but  has  never  prevailed  extensively  in  this 
country.  It  has  not  been  observed  in  the  United  States  since 
1871. 

The  predisposing  causes  of  relapsing  fever  are,  above  all, 
bad  sanitary  surroundings.  Want  and  overcrowding  seem  to  be 
much  less  important  factors  than  in  typhus  fever. 

Although  relapsing  fever  has,  since  it  was  first  clearly  dis- 
tinguished from  typhus  and  other  continued  fevers,  been  recog- 
nized as  an  eminently  contagious  and  infectious  disease,  it  was 

1  London,  1770. 


328  TEXT-BOOK   OF   HYGIENE. 

not  until  1873  that  its  immediate  cause  became  known.  In  that 
rear  Obermeier  discovered  in  the  blood  of  patients  ill  with  this 
disease  a  minute,  spiral,  mobile  organism,  now  known  as  the 
spirillum  or  spirochete  Obermeieri. 

Obermeier  and  other  observers,  prominent  among  whom  is 
Dr.  Henry  V.  Carter,  have  demonstrated  the  constant  presence 
of  these  organisms  in  the  blood  during  the  attack.  Carter  and 
Koch  have  induced  the  disease  in  monkeys  by  inoculation  of  the 
parasite,  and  Moschutkowski  has  successfully  inoculated  it  in  the 
human  subject.  No  doubt  can  exist  at  the  present  day  that  the 
spirillum  of  Obermeier  is  the  true  cause  of  relapsing  fever. 

The  preventive  measures  consist  in  attention  to  details  of 
personal  hygiene ;  in  other  words,  local  sanitation,  disinfection 
of  infected  materials  (fomites),  and  complete  isolation  of  the  sick. 

TYPHOID   FEVER. 

The  first  accurate  clinical  accounts  of  typhoid  fever  date 
from  the  seventeenth  century,  when  Baglivi,  Willis,  Sydenham, 
and  others  described  cases  of  fever  which  in  their  clinical  char- 
acters correspond  to  the  disease  now  known  as  typhoid  fever. 
Strother,  however,  in  1729,  first  gave  a  description  of  the 
anatomical  characters  of  the  disease,  which  he  says  is  a  "  symp- 
tomatical  fever,  arising  from  an  inflammation,  or  an  ulcer,  fixed 
on  some  of  the  bowels."  Bretonneau  and  Louis,  in  France; 
Hildenbrand,  in  Germany ;  William  Jenner,  in  England ;  and 
Drs.  Gerhard  and  Pennock,  in  this  country,  clearly  pointed  out 
the  essential  distinction  between  typhoid  and  other  fevers,  during 
the  first  half  of  the  present  century. 

At  the  present  day  typhoid  fever  is  met  with  everywhere 
throughout  the  world.  It  is  at  nearly  all  times  a  constituent  of 
mortality  tables.  It  affects  by  preference  persons  between 
the  ages  of  15  and  30  years,  although  no  age  is  entirely 
exempt.    It  is  always  more  prevalent  in  the  autumn  and  winter. 

The  disease  is  probably  due  to  an  organic  poison,  which 
gains  entrance  into  the  body  through  the  respiratory  or  digestive 


TYPHOID    FEVER.  329 

tract.  Recent  observations  of  Klebs  and  Eberth  seem  to  indicate 
that  the  morbific  agent  is  a  micro-organism  termed  the  bacillus 
typhoideus.  The  exact  relation  of  this  organism  to  the  disease 
has  not  been  clearly  worked  out.  It  is  found  in  the  intestinal 
canal,  and  especially  in  the  characteristic  intestinal  lesions  of 
this  fever.  The  infective  agent  is  probably  contained  in  the 
dejections  of  patients.  The  disease  is  not  immediately  conta- 
gious, like  typhus  fever. 

The  medium  through  which  the  poison  is  introduced  into 
the  body  may  be  drinking-water,  food,  milk,  or  other  articles 
containing  the  infective  agent.  Localized  epidemics  due  to 
infected  water  or  milk  have  been  frequently  reported.1 

The  typhoid  poison  is  supposed  to  be  developed  in  cess- 
pools, sewers,  and  soil  polluted  by  the  products  of  animal  decom- 
position. Whether  it  ever  originates  de  novo  in  such  places  is 
a  much-disputed  proposition.  At  present  the  evidence  is  in 
favor  of  the  view  that  cases  of  typhoid  fever  are  always  derived 
from  pre-existing  cases.  The  germ  may  develop  in  sewers  and 
be  carried  in  the  sewer-air  from  place  to  place  ;  it  may  be  carried 
into  the  soil  from  cess-pools  receiving  typhoid  dejections,  and 
there,  undergoing  development,  may  ascend  through  houses 
with  the  ground-air,  or  may  drain  into  wells  and  pollute  the 
drinking-water.  By  the  admixture  of  such  water  with  milk  or 
other  food  the  disease  may  be  propagated.  It  is  also  believed 
that  the  effluvia  from  typhoid  discharges  may  be  absorbed  by 
water  or  milk,  and  thus  infect  these  articles. 

The  prophylactic  measures  against  typhoid  fever  comprise 
isolation  of  the  sick,  prompt  disinfection  of  the  discharges,  and 
cleanliness  in  the  widest  sense.  The  water-  and  food-  supplies 
must  be  carefully  guarded  against  contamination  with  the  poison, 
and  all  decomposing  animal  matter  and  excreta  must  be  removed 
from  the  immediate  vicinity  of  dwellings.  The  requisites  for 
prevention  may  be  summed  up  as  pure  air,  pure  water,  uncon- 
taminated  food,  and  a  clean  soil. 

1  See  ante,  pp.  61-64. 


330  TEXT-BOOK   OF   HYGIENE. 

TYPHUS   FEVER. 

Wide-spread  pestilences  are  nearly  always  accompaniments 
of  famine  and  war.  Of  all  pestilential  diseases,  none  is  so  regu- 
lar in  its  coincidence  with  these  conditions  as  typhus  fever.  The 
earliest  accounts  which  unquestionably  refer  to  this  disease  date 
from  the  eleventh  century,  when  it  was  observed  at  a  number  of 
places  in  Italy.  In  the  succeeding  centuries  isolated  accounts 
of  it  appeared  in  the  chronicles  of  the  times,  but  no  scientific 
description  of  it  appeared  until  the  sixteenth  century.  During 
the  seventeenth,  eighteenth,  and  the  early  part  of  the  nineteenth 
centuries  it  prevailed  extensively  throughout  Europe.  The 
constant  wars  and  consequent  disturbances  of  the  social  rela- 
tions of  the  people,  famines,  overcrowding,  filth,  excesses  of  all 
kinds,  contributed  largely  to  the  development  and  spread  of 
typhus  fever.  For  a  number  of  years  past  no  extensive  epi- 
demic of  the  disease  has  been  observed,  although  both  in  this 
country  and  in  Europe  localized  outbreaks  are  frequently  met 
with. 

Typhus  fever  is  softie  what  more  prevalent  in  the  winter  and 
early  spring  months  than  during  the  rest  of  the  year,  but  not 
very  markedly  so.  . 

At  present,  typhus  fever  is  nearly  always  limited  to  times 
and  places  where  the  conditions  favoring  its  development  exist. 
Wherever  overcrowding,  in  connection  with  filth,  insufficient 
food,  and  bad  habits  are  present,  typhus  fever  is  likely  to  be  a 
visitor.  Thus,  in  overcrowded  and  ill-ventilated  emigrant  ships, 
in  jails  and  work-houses,  and  in  camps,  especially  when  stress 
of  weather  compels  the  crowding  together  of  soldiers  in  close 
huts  or  barracks,  the  disease  frequently  breaks  out. 

When  typhus  fever  appears  in  a  community,  those  classes 
of  the  people  who  are  subjected  to  the  conditions  just  mentioned 
are  almost  exclusively  attacked.  In  cities,  the  dwellers  in 
crowded  tenements,  or  in  courts  and  alleys,  suffer  most  severely — 
are,  in  fact,  almost  the  only  ones  attacked.  An  exception  must, 
however,  be  made  in  the  case  of  hospital  physicians  and  attend- 


YELLOW   FEVER.  331 

ants  where  typhus-fever  patients  are  treated.  The  mortality 
among  these  is  always  large. 

Typhus  fever  is  contagious  and  infectious.  An  exposure 
for  a  length  of  time  to  an  atmosphere  impregnated  with  the 
poison  may  suffice  to  induce  an  attack.  The  poison  may  also 
be  conveyed  from  place  to  place  in  fomites.  Physicians  may 
carry  it  in  their  clothing,  if  they  have  been  exposed  to  a  typhus 
atmosphere. 

The  prevention  of  typhus  fever  consists  in  the  institution- of 
such  measures  as  will  secure  pure  air,  pure  water,  a  clean  soil 
and  dwellings,  and  cleanliness  of  body  and  clothing.  When  an 
outbreak  occurs,  the  sick  should  be  promptly  isolated,  the  well 
persons  removed  from  the  building  in  which  the  cases  have 
occurred,  and  efficient  measures  of  disinfection  carried  out.  The 
sick  should  be  treated  in  the  open  air  as  much  as  possible. 

YELLOW   FEVER. 

The  West  India  Islands,  the  Gulf  coast  of  Mexico,  the 
northern  part  of  the  Atlantic  coast  of  South  America,  and  a 
limited  section  of  the  west  coast  of  Africa  constitute  the  present 
home  of  yellow  fever.  From  this  area  (the  so-called  "  yellow- 
fever  zone  ")  the  disease  is  frequently  transported  to  contiguous 
or  distant  countries.  The  South  Atlantic  and  Gulf  coasts  of  the 
United  States  and  the  shores  of  the  Caribbean  Sea  are  most 
liable  to  the  epidemic  visitation  of  this  pestilence. 

The  first  trustworthy  account  of  an  epidemic  of  yellow 
fever  dates  from  the  year  1635,  when  it  prevailed  on  the  Island 
of  Guadeloupe.  This  and  the  adjoining  islands  of  Dominica, 
Martinique,  and  Barbadoes  were  invaded  a  number  of  times  in 
the  fifty  years  following  the  above  date.  Jamaica  was  invaded 
in  1655  and  Domingo  the  year  after.  In  1693  the  first  appear- 
ance of  the  disease  is  mentioned  in  the  United  States,  being 
observed  in  Boston,  Philadelphia,  and  Charleston.  In  1699  it 
appeared  as  an  epidemic  in  Vera  Cruz,  and  re-appeared  in  Phila- 
delphia  and  Charleston.     Since  the  year  1700,  the  disease  has 


332  TEXT-BOOK   OF   HYGIENE. 

appeared  in  an  epidemic  form,  at  one  or  more  places  within  the 
present  limits  of  the  United  States,  eighty  times,  the  last  consid- 
erable invasion  being  at  Jacksonville  and  other  places  in  Florida, 
and  Decatur  in  Alabama,  in  1888. 

In  South  America  yellow  fever  appeared  for  the  first  time 
in  1740.  In  1849  the  disease  was  imported  into  Brazil,  and 
has  since  then  been  endemic.  Peru  and  the  Argentine  Republic 
have  also  suffered  several  severe  visitations  of  yellow  fever  since 
1854. 

On  the  west  coast  of  Africa,  yellow  fever  seems  to  be  en- 
demic in  the  peninsula  of  Sierra  Leone,  where  it  has  been  fre- 
quently observed  since  1816.  It  has  also  prevailed  epidemically 
in  Senegambia  and  a  number  of  the  islands  off  the  northern 
portion  of  the  west  African  coast.  In  Europe,  Spain  and  Por- 
tugal have  been  the  only  countries  to  suffer  from  yellow-fever 
epidemics. 

Although  the  causes  of  yellow  fever  cannot  be  definitely 
stated,  it  is  well-known  that  it  only  occurs  endemically  within 
the  tropics,  and  prevails  epidemically  elsewhere  only  during  the 
summer.  Of  180  epidemics  observed  in  the  United  States  and 
Bermudas,  154  began  in  July,  August,  and  September.  Of  the 
remaining  26,  none  began  in  the  six  months  from  November  to 
April. 

A  temperature  of  26°  C.  and  a  high  humidity  are  gener- 
ally considered  essential  to  produce  an  outbreak  of  the  disease. 
Of  other  necessary  meteorological  conditions  nothing  is  known. 

That  the  specific  cause  of  yellow  fever  is  a  micro-organism 
appears  probable  from  a  consideration  of  the  clinical  history  of 
the  disease  and  its  mode  of  propagation.  Up  to  the  present 
time,  however,  none  of  the  various  organisms  described  as  causa- 
tive have  made  good  the  claims  advanced  by  their  discoverers. 
It  can  be  stated  without  reserve  that  neither  the  organism  of 
Freire,  of  Carmona,  of  Babes,  of  F.  S.  Billings,  of  Finlay,  or  of 
Gibier,  is  the  true  cause  of  yellow  fever. 

It  seems  to  be  well  established  that  the  most  filthy  and 


YELLOW   FEVER.  333 

insanitary  portions  of  cities  are  those  principally  ravaged  by 
yellow  fever.  The  author  is  convinced  from  personal  observa- 
tion in  Savannah,  Memphis,  and  New  Orleans,  that  filth  is  one 
of  the  principal  factors  in  the  spread  of  yellow  fever.  This 
opinion  is  also  forcibly  expressed  by  many  of  the  most  eminent 
authorities  on  the  subject. 

Yellow  fever  is  not  endemic  within  the  limits  of  the  United 
States,  and  has  probably  never  originated  here.  The  instances 
in  which  it  has  appeared  to  do  so  may  be  explained  by  the  per- 
sistence of  the  morbific  agent  through  one  or  more  winters,  or 
by  a  new  importation  which  has  escaped  observation. 

Yellow  fever  frequently  breaks  out  on  shipboard  and  causes 
much  loss  of  life.  There  is  no  evidence  that  it  originates  on 
ships ;  it  is  only  acquired  after  intercourse  with  an  infected  ship 
or  infected  place. 

The  question  of  the  personal  contagion  of  yellow  fever  has 
been  decided  negatively.  The  disease  is  infectious  and  its  cause 
may  be  transported  in  fomites,  but  persons  sick  with  the  disease 
do  not  communicate  it.  An  infected  atmosphere,  or  one  favor- 
able to  the  poison,  is  necessary  to  the  propagation  of  the  disease. 

The  preventive  measures  indicated  against  yellow  fever 
appear  from  the  foregoing:  they  are  strict  sanitary  inspection  to 
prevent  the  introduction  of  a  person  sick  with  the  disease;  to 
prevent  the  introduction  of  clothing  or  other  fomites  from  a 
suspected  locality  without  thorough  disinfection,  and  such  a  con- 
dition of  public  and  private  sanitation  as  will  prevent  the  devel- 
opment of  the  poison,  should  the  latter,  perchance,  be  introduced. 

When  the  disease  becomes  epidemic  in  a  city,  the  inhabi- 
tants should  be  removed  to  temporary  camps  beyond  the  infected 
area.  The  experience  of  the  city  of  Memphis  in  1879,  and  of 
various  localities  in  Florida  in  1888,  encourages  the  hope  that 
by  prompt  depopulation  of  cities  and  strict  enforcement  of  sani- 
tary measures  in  the  camps  the  terrors  of  yellow  fever  can  be 
largely  averted.  The  sick  should  be  promptly  isolated,  and  no 
one  except  attendants  permitted  to  have  intercourse  with  them. 


334  TEXT-BOOK   OF   HYGIENE. 

SCARLET   FEVER   AND    MEASLES. 

The  early  history  of  these  two  contagious  eruptive  fevers  is 
inextricably  blended  together.  Up  to  the  latter  half  of  the 
seventeenth  century  the  distinction  between  the  two  was  not 
made  by  writers.  Sydenham  was  among  the  first  who  clearly 
separated  scarlet  fever  from  measles  and  gave  it  a  distinct  name. 
Since  the  great  English  Hippocrates,  the  essential  character  of 
scarlet  fever  has  been  recognized  by  all  physicians,  and  it  is  now 
never,  or  but  rarely,  confounded  with  measles. 

Of  the  two  diseases,  measles  is  somewhat  more  generally 
prevalent,  although  both  occur  usually  in  epidemics.  There  is 
hardly  a  country  in  which  measles  has  not  been  observed,  while 
the  continents  of.  Asia  and  Africa  have  remained  measurably 
exempt  from  scarlet  fever  up  to  the  present  time,  although  epi- 
demics have  been  recorded  in  India  and  Japan. 

Hirsch  states  that  scarlet  fever  was  first  observed  in  this 
country  in  1735,  at  Kingston,  Mass.,  quoting  as  authorities  Dr. 
Douglass,  of  Boston,  and  Dr.  Colden,  of  New  York.  The 
latter,  however,  in  a  letter  to  Dr.  Fothergill,1  clearly  describes 
diphtheria,  and  not  scarlet  fever.  Its  distribution  is  now  general, 
but  it  is  said  to  be  much  milder  in  the  southern  than  in  other 
portions  of  the  United  States.  The  prevalence  of  measles  is  not 
limited  to  any  geographical  section. 

Epidemics  of  measles  usually  begin  during  cold  weather. 
Of  530  epidemics  observed  in  Europe  and  North  America,  339 
occurred  during  the  colder  and  191  during  the  warmer  months. 
In  213  of  these,  the  height  of  the  epidemic  occurred  135  times 
in  winter  and  spring,  and  only  78  times  during  summer  and 
autumn.  Scarlet  fever  epidemics  occur  more  frequently  in 
autumn  than  at  any  other  season. 

The  cause  of  scarlet  fever  or  of  measles  is  not  to  be 
sought  in  climatic  influences,  insanitary  surroundings,  or  special 
natural  conditions  of  air,  water,  or  soil.  Both  diseases  are 
contagious  and  infectious,  and  the  contagion  is  transmitted  either 

1  Medical  Observations  and  Inquiries,  vol.  i,  p.  211.    London,  1776. 


DIPHTHERIA.  335 

by  fomites  (clothing,  letters,  etc.),  infected  air,  drinking-water, 
or  milk. 

Several  observers  have  claimed  the  discovery  of  the  specific 
organism  of  scarlet  fever,  but  no  trustworthy  evidence  has  yet 
been  furnished  that  the  problem  is  solved.  On  a  previous  page 
(93)  reference  has  been  made  to  the  probable  connection  between 
a  disease  of  milk-cattle  and  scarlet  fi^ver. 

The  measures  for  the  prevention  of  both  diseases  are  isola- 
tion and  thorough  disinfection. 

DIPHTHERIA. 

Under  the  names  of  Syriac  and  Egyptian  ulcers,  Arets?us, 
a  writer  of  the  second  century,  described  various  forms  of  malig- 
nant sore  throat.  The  disease  now  called  diphtheria  prevailed  at 
various  places  in  Europe  during  the  Middle  Ages.  In  this  country 
it  was  first  observed  about  the  middle  of  the  last  century,  and 
in  1771  Dr.  Samuel  Bard,  of  New  York,  described  it  very 
accurately.  Although  repeated  severe  outbreaks  occurred  in 
Europe  in  the  early  part  of  the  present  century,  it  was  not  until 
1857  that  it  again  attracted  attention  by  its  epidemic  prevalence 
in  the  United  States.  Since  that  time  it  has  spread  throughout 
the  country,  and  is  at  present  one  of  the  most  generally  diffused, 
as  well  as  one  of  the  most  fatal,  of  the  contagious  diseases.  In 
certain  epidemics  its  malignancy  is  very  marked,  while  in  others 
it  seems  to  be  a  rather  mild  affection. 

Diphtheria  is  personally  contagious;  it  may  be  transmitted 
by  inoculation,  as  well  as  by  inhaling  an  infected  atmosphere. 
The  virus  is  supposed  by  some  investigators  to  dwell  in  a  micro- 
organism, but  no  agreement  has  been  reached  as  to  the  character 
of  the  specific  microbe.1 

The  question  as  to  the  identity  of  diphtheria  and  croup  is 
not  merely  a  clinical  one,  but  has  an  important  bearing  upon 
preventive  medicine.  If  croup  is  a  non-contagious  and  non- 
infectious disease,  as  is  held  by  many,  no  precautions  will  be 

1  Wood  and  Formad,  Klebs  and  Loffler,  Emmerich,  and  T.  Mitchell  Prudden. 


336  TEXT-BOOK   OF   HYGIENE. 

necessary  to  prevent  its  spread  to  healthy  persons.  If,  on  the 
other  hand,  diphtheria  and  croup  are  identical  in  nature,  the 
danger  of  infection  is  equally  great  in  both  diseases.  Inasmuch 
as  it  is  frequently  impossible  to  positively  decide  upon  a  diagnosis, 
it  would  be  well  to  consider  the  identity  of  the  two  diseases  as 
established,  and  act,  as  far  as  preventive  measures  are  concerned, 
as  if  all  were  cases  of  diphtheria. 

Diphtheria  is  inoculable  upon  animals,  and  may  through 
this  medium  be  transmitted  to  man. 

Persons  sick  with  diphtheria  should  be  carefully  isolated  ; 
no  one  but  the  immediate  attendants  should  be  allowed  to  come 
in  contact  with  the  patients.  Table  utensils,  bedding,  and  cloth- 
ing used  by  the  sick  should  be  thoroughly  disinfected  by  steam 
or  boiling  water  before  being  used  by  others.  Intimate  contact 
with  the  sick,  such  as  kissing,  should  be  strictly  prohibited. 
There  seems  no  room  to  doubt  that  the  virus  of  the  disease  can 
also  be  carried  in  the  clothing.  Hence,  physicians  and  nurses 
should  be  especially  careful  in  personally  disinfecting  themselves 
after  contact  with  a  case  of  diphtheria.  After  death  or  recovery 
of  the  patient,  the  apartment  occupied  during  the  illness  should 
be  disinfected  with  chlorine  or  sulphurous-acid  gas. 

Children  recovering  from  diphtheria,  scarlet  fever,  measles, 
or  small-pox,  should  not  be  permitted  to  attend  school  for  at 
least  four  weeks  after  recovery.  It  is  believed  that  there  is 
danger  of  infection  for  a  period  about  as  long  as  this,  and,  besides, 
the  patients  are  apt  to  be  weakened  from  the  effects  of  the  dis- 
ease, and  not  able  to  resist  the  strain  of  continuous  mental  effort. 

DENGUE. 

The  disease  known  as  break-bone  fever,  dandy  fever,  and 
by  various  other  names,  was  first  observed  in  the  United  States 
in  1780  by  Dr.  Benjamin  Rush.  Dr.  Rush  describes  an  epi- 
demic which  prevailed  during  the  summer  and  early  autumn  of 
that  year  under  the  name  of  "  bilious  remittent  fever,"  but  the 
symptoms  of  the   disease  hardly  leave  any  doubt  that  it  was 


DENGUE.  337 

dengue.  In  1779  and  1780  it  was  also  observed  on  the  Coro- 
mandel  coast,  in  Egypt,  and  on  the  island  of  Java.  In  1784  to 
1788  dengue  also  prevailed  in  various  cities  of  Spain.  In  1818 
an  epidemic  appeared  in  Lima,  in  which  nearly  every  one  of  the 
70,000  inhabitants  was  attacked. 

In  182-4-25  the  disease  again  prevailed  widely  in  India, 
where  it  was  known  as  the  "  three-day  fever."  Isolated  out- 
breaks occurred  in  that  country  until  1853,  when  it  again  ap- 
peared as  a  wide-spread  epidemic,  and  in  1872  another  epidemic 
outbreak  occurred  in  the  East,  extending  from  Eastern  Africa 
to  Arabia,  India,  and  China. 

In  1826  an  epidemic  of  dengue  appeared  in  Savannah,  and 
in  the  following  two  years  spread  over  the  southern  portion  of 
.the  United  States  and  the  West  Indies,  reaching  the  northern 
coast  of  South  America.  In  1845  to  1849  the  disease  was 
observed  in  Rio  Janeiro ;  in  1848  to  1850  in  the  South  Atlantic 
and  Gulf  States.  In  1854  it  was  observed  in  Southern  Alabama, 
and  in  the  same  year  in  the  West  Indies.  In  1873  another 
epidemic  appeared  in  the  lower  Mississippi  Valley,  and  in 
1880  an  outbreak  of  some  extent  occurred  in  New  Orleans, 
Charleston,  and  other  places  on  the  Gulf  and  South  Atlantic 
coasts. 

Dengue  always  begins  in  the  summer  or  early  autumn,  and 
ceases  abruptly  with  the  advent  of  cold  weather.  It  is  almost 
exclusively  limited  to  hot  countries.  It  spreads  with  extreme 
rapidity  wherever  it  appears.  It  is  not  contagious ;  the  man- 
ner of  its  propagation  is  not  known.  The  susceptibility  to  the 
disease  appears  to  be  almost  universal ;  it  frequently  prostrates 
the  majority  of  the  inhabitants  where  an  outbreak  occurs. 
During  the  epidemic  in  Calcutta  in  1871-72,  75  per  cent,  of  the 
population  were  attacked.  In  the  United  States  similar  epi- 
demics have  been  repeatedly  observed. 

Dengue  is  rarely  fatal.  It  seems  to  be  propagated  through 
the  atmosphere.  No  measures  of  prevention  are  known  or 
available. 

22 


338  TEXT-BOOK   OF   HYGIENE. 

EPIDEMIC    INFLUENZA. 

Accounts  of  epidemic  influenza  can  be  traced  back  to  the 
year  1173,  when  the  disease  was  observed  coincidently  in  Italy, 
Germany,  and  England.  It  has  prevailed  epidemically,  at  vary- 
ing intervals,  to  the  present  time.  In  the  fourteenth  century 
3  epidemics  are  recorded ;  in  the  fifteenth,  4 ;  in  the  sixteenth, 
7;  in  the  seventeenth,  46.  Of  these,  15  were  very  extensive, 
some  of  them  prevailing  over  both  hemispheres  contempo- 
raneously. 

On  the  American  continent  influenza  was  first  recorded  in 
1627,  when  it  prevailed  in  New  England,  where  it  again  broke 
out  in  1625.  Following  this  there  is  no  notice  of  the  disease 
in  America  until  1732,  when  an  epidemic  began  in  the  New 
England  States,  which  extended  over  the  entire  globe.  Epi- 
demics occurred  during  the  remainder  of  the  eighteenth  cen- 
tury in  1737,  1757,  1761,  1767,  1772,  1781,  1789,  and  1798. 
During  the  present  century  the  disease  has  prevailed  more  or 
less  extensively  in  this  country  at  thirteen  different  times,  the 
last  epidemic  of  any  considerable  extent  being  in  1879. 

At  the  time  of  writing  (February,  1890)  a  very  wide- 
spread epidemic,  which  began  in  Russia  in  November,  1889,  is 
prevailing  in  the  United  States,  complicated  in  many  cases  by 
pneumonia  of  a  fatal  character.  The  disease  manifests  itself 
in  two  principal  forms,  the  catarrhal  and  the  nervous.  Weich- 
selbaum,  of  Vienna,  claims  to  have  discovered  a  micro-organism 
which  he  believes  to  be  the  cause  of  the  affection,  but  this 
claim  has  not  yet  been  verified. 

A  curious  feature  of  epidemics  of  influenza  is  the  coinci- 
dent occurrence  of  outbreaks  of  a  somewhat  similar  affection 
among  animals,  horses  and  dogs  being  especially  attacked. 

Influenza  is  an  acute,  specific,  infectious  disease,  not  di- 
rectly contagious.  The  infection  is  apparently  produced  or  trans- 
mitted in  the  air.  The  disease  frequently  appears  over  a  large 
area  of  country  almost  simultaneously.  Peculiarities  of  climate, 
season,  meteorological  conditions,  geological  formation,  or  racial 


EPIDEMIC   CEREBROSPINAL   MENINGITIS.  339 

characteristics  have  no  apparent  influence  upon  the  causation  or 
spread  of  the  disease.  It  occurs  more  frequently  in  the  winter 
and  spring  than  during  the  summer  or  autumnal  months.  The 
investigation  into  the  epidemic  of  influenza  among  horses,  re- 
ferred to  in  a  previous  chapter,1  seems  to  indicate,  however,  that  a 
moist  and  impure  atmosphere  intensifies  the  disease. 

No  measures  of  prophylaxis  can  be  indicated  except  avoid- 
ance of  anything  tending  to  depress  the  vital  powers. 

EPIDEMIC    CEREBRO-SPINAL    MENINGITIS. 

This  disease  was  first  recognized  in  Geneva  in  1805.  In 
the  following  year  it  was  noted  in  various  places  in  the  United 
States.  Both  in  Europe  and  this  country  localized  outbreaks 
of  the  disease  occurred  between  the  dates  above  mentioned  and 
1816.  At  this  time  the  disease  seemed  to  die  out  altogether, 
but  in  1822  it  re-appeared  in  various  parts  of  Europe  and 
America. 

Cerebro-spinal  meningitis  appeared  in  1857  in  the  south- 
west of  France,  and  during  the  following  ten  years  spread  over 
a  large  part  of  the  country.  Algiers,  Italy,  Denmark,  and  Ire- 
land were  also  visited  by  the  scourge.  In  1854  and  1861 
Sweden  experienced  its  ravages,  and  in  1859  Norway  was 
invaded  by  the  disease,  which  continued  for  nearly  a  decennium 
in  the  latter  country.  From  1860  to  1867  the  disease  prevailed 
in  Holland,  Portugal,  Germany,  Ireland,  and  Russia. 

After  the  termination  of  what  may  be  called  the  first  epi- 
demic, in  1816,  cerebro-spinal  meningitis  was  not  again  observed 
in  this  country  until  1842.  In  the  eight  years  succeeding,  it 
prevailed  epidemically  throughout  almost  the  whole  United 
States.  From  1861  to  1873  it  was  noted  frequently  in  various, 
parts  of  the  country.  Since  the  latter  year  the  reports  of  its 
occurrence  in  this  country  have  been  limited  to  sporadic  cases 
or  localized  outbreaks. 

Cerebro-spinal  meningitis  is  an  acute  infectious   disease, 

1  Chapter  I,  p.  29. 


340  TEXT-BOOK    OF    HYGIENE. 

very  fatal  in  its  tendency.  It  is  probably  not  personally  con- 
tagious. Climate  has  no  influence  upon  its  origin,  but  season 
seems  to  stand  in  a  positive  relation  to  its  causation.  About 
three-fourths  of  the  epidemics  noticed  have  occurred  during  the 
winter  and  spring  months.  The  disease  seems  to  show  no 
preference  for  peculiarities  of  topographical  or  geographical 
formation.  Overcrowding,  overwork,  and  uncleanliness  have 
an  important  influence  in  determining  an  outbreak.  It  is 
especially  a  disease  of  youth  and  adolescence.  Out  of  975 
cases  occurring  in  New  York  only  150  were  over  20  years  of 
age,  while  of  the  remainder  665  were  under  10. 

The  prophylactic  measures  to  be  adopted  against  cerebro- 
spinal meningitis  consist  in  careful  attention  to  the  sanitary 
conditions  of  dwellings  and  streets,  avoidance  of  overwork  and 
overcrowding  during  times  of  epidemic,  isolation  of  the  sick, 
and  disinfection  of  the  sick-room  after  the  termination  of  the 
disease. 

SYPHILIS. 

In  the  year  1494,  Charles  VIII,  of  France,  in  command  of 
a  large  army  invaded  Italy,  and  early  in  the  following  year  be- 
sieged Naples.  During  the  investment  of  the  city  a  very  severe 
disease,  characterized  by  ulcers  of  the  genitals,  violent  pains  in 
the  head  and  limbs,  and  generalized  cutaneous  eruptions  broke 
out  among  the  besiegers  and  spread  rapidly  throughout  the 
army  and  civil  population.  On  the  return  of  the  army  to  .prance, 
after  the  termination  of  the  war,  the  disease  rapidly  spread 
throughout  Europe,  and  the  literature  of  the  early  part  of  the 
sixteenth  century,  both  medical  and  lay,  teems  with  references 
to  it. 

From  the  locality  and  other  circumstances  connected  with 
its  epidemic  appearance  the  disease  acquired  various  names. 
Thus,  the  French  called  it  morbus  Neapolitanus,  or  mal  d'ltalie, 
while  the  Italians  termed  it  morbus  Gatticus,  or  mala  Franzos. 
At  a  very  early  period  it  was,  however,  clearly  recognized  that 
the  disease  was  communicated  during  sexual  intercourse,  and 


SYPHILIS.  341 

hence  it  was  usually  described  in  medical  writings  under  the 
name  hies  venerea,  while  in  the  popular  literature  it  still  figured 
as  the  Frenchman's  disease  (morbus  Gallicus).  The  name  syphilis 
was  first  used  in  a  poem  descriptive  of  the  disease,  written  in 
1521  by  Fracastor,  a  physician  of  Verona. 

The  extraordinary  outbreak  of  the  disease  toward  the  end 
of  the  fifteenth  century  led  to  many  speculations  concerning  its 
origin.  As  it  attacked  persons  in  all  ranks  and  conditions  of 
life,  "sparing  neither  crown  nor  cross,"  in  the  words  of  a  con- 
temporary poet,  the  favorite  explanation  was  that  meteorological 
influences  had  much  to  do  with  its  causation.  Many  ascribed 
it  to  the  malign  influence  of  the  stars.  The  Neapolitans  attrib- 
uted it  to  the  wickedness  of  their  enemies,  the  French,  while 
the  latter  laid  the  blame  on  the  filth  and  immorality  of  the 
Italians.  The  Spaniards  claimed  that  it  had  been  imported  from 
America  by  Columbus,  whose  first  expedition  returned  to  Europe 
in  1493.  There  are  records,  however,  which  prove  that  the  dis- 
ease already  existed  in  Italy  in  the  latter  year.  In  other  parts 
of  Europe  the  Jews,  who  had  been  driven  out  of  Spain  by  the 
terrors  of  the  Inquisition,  were  accused  of  this,  as  of  many  other 
misfortunes  which  befell  the  people.  When  it  was  definitely 
established  that  the  disease  was  communicated  almost  solely  by 
sexual  intercourse,  the  theory  of  its  transatlantic  origin  became 
very  popular.  It  is  characteristic  of  human '  nature  to  refer 
the  origin  of  troubles  resulting  from  its  own  vices  to  some  other 
source,  if  possible.  This  theory  of  the  American  origin  of 
syphilis  is  still  held  by  some  writers.  Within  a  few  years,  Dr. 
Joseph  Jones,  of  New  Orleans,  claims  to  have  found  evidences 
of  syphilitic  disease  in  the  skulls  and  other  bones  from  some  of 
the  prehistoric  Indian  mounds  in  Mississippi.  These  observa- 
tions of  Dr.  Jones  have,  however,  not  yet  been  verified  by  others. 

Although  the  first  great  epidemic  of  syphilis  is  clearly  trace- 
able to  the  period  between  the  years  1493  and  1496,  an  ex- 
amination of  the  older  literature  reveals  many  descriptions  of 
disease  which  can  only  be  explained  by  assuming  them  to  refer 


312  TEXT-BOOK   OF   HYGIENE. 

to  syphilis.  The  Old  Testament  Scriptures  contain  numerous 
references  to  diseases  of  the  genital  organs.  In  most  instances 
these  troubles  are  ascribed  to  the  wrath  of  God,  although  in 
some  cases  a  pretty  shrewd  hint  is  given  as  to  the  causation  of 
the  affections.  Finaly1  remarks  that  the  Hebrew  word  trans- 
lated in  all  versions  of  the  Bible  by  "  flesh"  signifies  also  the 
virile  member.  In  this  light,  the  references  in  Leviticus,  XIII- 
XV;  Numbers,XXV,  1-9,  XXXI,  16-18;  Deuteronomy,  IV,  3 ; 
Joshua,  XXII,  17 ;  I  Samuel,  V,  6,  9,  12 ;  Psalms,  CVI,  28-30 ; 
I  Corinthians,  X,  8;  Ephesians,  II,  11 ;  and  Colossians,  II,  13, 
receive  a  new  interpretation.  Numerous  innuendoes  in  the 
Latin  classics,  and  more  or  less  exact  descriptions  in  the  medical 
writings  of  Greece,  Rome,  China,  and  India,  leave  no  room  for 
doubt  that  venereal  diseases,  and  probably  among  them  syphilis, 
have  existed  from  the  earliest  times. 

At  the  present  day  syphilis  is  the  most  widely  prevalent  of 
all  contagious  diseases.  In  1873  Dr.  F.  R.  Sturgis  estimated 
that  in  New  York  1  person  out  of  every  18  suffered  from  it. 
This  is  considered  a  moderate  estimate.  Dr.  J.  Wm.  White, 
of  Philadelphia,  pronounces  the  opinion  that  "not  less  than 
50,000  people  of  all  classes  in  that  city  are  affected  with  syphilis." 
On  this  basis  Gihon  estimates  the  number  of  syphilitics  in  the 
United  States  at  one  time  at  2,000,000.2 

The  disease  is  transmitted,  in  the  vast  majority  of  cases, 
during  the  performance  of  the  sexual  act,  but  there  are  numerous 
other  ways  in  which  it  may  be  and  frequently  is  communicated. 
In  the  special  literature  of  the  subject  are  records  of  many  cases 
in  which  the  disease  was  acquired  through  a  kiss,  a  bite,  the  act 
of  suckling  (from  infant  to  nurse,  and  conversely),  using  a  pipe, 
glass-blowers'  mouth-piece,  the  finger  of  a  midwife,  the  instru- 
ments of  the  dentist  or  surgeon,  inoculation  of  syphilitic  secretion 
mixed  with  saliva  in  the  process  of  tattooing,  and  many  other 
ways.  Numerous  cases  have  been  reported  where  physicians  were 
inoculated  on  the  finger  while  examining  a  syphilitic  patient. 

1  Arch.  f.  Dermat.  u.  Syphilis,  II  Jahrg.    1  Heft.,  p.  126. 

1  The  Prevention  of  Venereal  Diseases  by  Legislation,  Sanitarian,  June,  1882. 


DISEASES   OF    ANIMALS   COMMUNICABLE    TO    MAN.  343 

The  prophylactic  measures  which  suggest  themselves  from 
a  consideration  of  the  nature  of  the  disease  are  isolation  of  those 
infected,  regular  inspection  of  the  class  of  persons  through  whom 
the  disease  is  most  frequently  transmitted,  i.e.,  prostitutes,  and 
individual  precautions  against  acquiring  it.  Greater  attention 
to  cleanliness  of  the  genital  organs  on  the  part  of  those  indulg- 
ing in  promiscuous  intercourse  would  aid  largely  in  reducing 
the  number  of  cases  of  syphilis. 

DISEASES    OF    ANIMALS   COMMUNICABLE   TO   MAN. 

Sheep)-pocJc.— This  is  a  highly  contagious  and  infectious 
disease  of  sheep,  resembling,  in  its  symptoms,  course,  and  fatality, 
small-pox  as  it  occurs  in  the  human  race.  It  is  believed  by 
Bollinger  to  be  different  from  the  form  of  small-pox  produced 
in  sheep,  goats,  horses,  and  other  animals  by  the  inoculation  of 
human  small-pox.  Sheep-pock  can  be  inoculated  upon  other 
animals  and  man,  but  only  produces  a  local  disease  at  the  point 
of  inoculation  in  the  latter.  Sheep  may  be  protected  against 
this  disease  by  inoculation  with  sheep-pock  virus  (ovination),  or 
by  vaccination  with  vaccine  lymph.  The  peculiarity  of  sheep 
vaccinia  is  that  it  is  a  more  or  less  generalized  disease,  the 
pustules  being  distributed  over  the  body.  Sheep-pock,  when 
inoculated  upon  human  beings,  does  not  produce  a  generalized 
infectious  disease,  but  remains  entirely  local. 

Actinomycosis. — Veterinarians  have  frequently  observed  a 
disease  attacking  the  jaws  of  cattle  and  producing  tumors,  often 
with  ulcerated  surfaces.  The  bone  is  usually  involved.  The 
disease  has  heretofore  been  generally  considered  a  sarcomatous 
growth.  It  is  not  seldom  observed  among  the  cattle  in  the 
western  stockyards,  where  it  is  known  in  the  vernacular  as 
"  swell-head."  Recent  investigations  by  Ponfick  have  shown 
that  the  growth  consists  of  a  vegetable  parasite  (actinomyces), 
and  that  it  is  inoculable  upon  other  animals,  and  may  be 
conveyed  to  man.  A  considerable  number  of  cases  have  been 
observed  in  human  beings  in  Germany,  where  the  disease  was 


344  TEXT-BOOK   OF   HYGIENE. 

first  described  by  Ponfick,  and  very  recently  4  cases  have 
been  reported  in  this  country.1 

Bovine  Tuberculosis  (Perls  ucht). — In  cattle,  tuberculosis 
occurs  in  two  forms,  miliary  tubercles  and  cheesy  masses  in  the 
lungs,  and  firm,  pearly  nodules  on  the  serous  membranes. 
These  nodules  do  not  break  down,  but  may  become  calcified. 

Bovine  tuberculosis  is  a  frequent  disease  among  cows  kept 
in  damp,  dark,  and  ill- ventilated  stables.  The  disease,  which  is 
essentially  the  same  as  human  tuberculosis,  tubercle  bacilli 
being  present  in  the  neoplasms,  is  believed  by  many  to  be  trans- 
missible to  human  beings  by  means  of  the  milk  or  flesh  of 
tuberculous  animals.  The  sale  of  the  meat  of  tuberculous  cattle 
should  be  prohibited. 

Rabies. — Hydrophobia  in  the  brute,  and  its  communi- 
cability  to  man  through  a  bite,  has  been  known  from  the 
remotest  antiquity.  It  occurs  in  dogs,  foxes,  wolves,  horses, 
and  other  animals,  and  may  be  transmitted  from  any  of  them  to 
human  beings. 

The  contagium  of  rabies,  the  infective  poison,  is  contained 
principally  in  the  saliva,  and  is  usually  inoculated  by  the  teeth 
of  the  mad  animal. 

Pasteur  has  shown  that  the  greatest  virulence  of  the  rabies 
poison  resides  in  the  brain  and  spinal  cord  of  the  animal  suffer- 
ing from  the  disease.  By  cultivation  of  this  virus,  the  nature 
of  which  has  not  yet  been  definitely  determined,  its  virulence 
could  be  diminished,  and  by  inoculation  of  men  and  animals 
with  the  attenuated  virus  protection  against  the  disease  could 
be  secured.  The  fact  seems  likewise  established  that  the  period 
of  incubation  of  the  inoculation-rabies  is  much  shorter  than  that 
acquired  in  the  usual  way  by  bites  of  rabid  animals.  Hence, 
inoculation  with  the  attenuated  virus  protects  the  bitten  individ- 
ual against  the  fatal  outbreak  of  the  unmodified  disease. 

Anthrax. — Anthrax,   or   splenic   fever   (milzbrand),   is   an 

1  Boston  Med.  and  Surg.  Journal,  Oct.  16,  1884,  p.  377,  and  Journ.  Am.  Med.  Ass'n,  Nov.  27, 
1886.    Also,  N.  E.  Med.  Monthly,  Sept.  15, 1886. 


DISEASES   OF   ANIMALS   COMMUNICABLE   TO   MAN.  345 

acute,  highly  contagious  and  infectious  disease  of  herbivorous 
animals,  which  may  be  transmitted  by  inoculation  or  the 
ingestion  of  the  virus  to  other  animals  and  to  man. 

The  disease  is  due  to  a  minute  vegetable  organism  which 
is  found  in  the  blood  and  tissues  of  the  diseased  animals.  This 
organism,  bacillus  authracis,  was  first  discovered  by  Pollender, 
and  has  been  thoroughly  investigated  by  Davaine,  Pasteur, 
Koch,  and  others. 

Inoculation  of  these  bacilli  or  their  spores  always  produces 
the  disease  in  susceptible  animals.  Skins  of  animals  not  infre- 
quently contain  the  virus,  which  may  then  gain  access  to  the 
blood  of  persons  engaged  in  handling  them.  Knackers, 
butchers,  wool-sorters,  and  other  persons  liable  to  come  in 
contact  with  sick  animals,  or  handling  their  flesh  or  hides,  are 
subject  to  the  infection,  either  by  direct  inoculation  (through 
abrasions  of  the  skin,  etc.)  or  by  inhalation  of  the  spores  of  the 
bacillus.  An  intestinal  form  of  anthrax  in  man,  mycosis  intes- 
tinalis,  is  sometimes  produced  by  the  consumption  of  meat  of 
animals  suffering,  when  killed,  of  splenic  fever.  Numerous 
instances  have  been  reported.  The  diagnosis  has  been  verified 
by  discovering  the  bacillus  of  anthrax  in  the  blood  and  various 
organs  of  the  individuals  attacked. 

In  view  of  the  dangerous  character  of  the  disease,  persons 
coming  in  contact  with  animals  suffering  from  anthrax  should 
be  warned  of  their  peril.  In  order  to  protect  other  animals  in 
a  herd,  strict  isolation  of  the  infected,  thorough  disinfection  of 
the  stables  occupied  by  them,  and  deep  interment  of  the  cadavers 
of  those  dead  from  the  disease  are  indicated. 

Glanders. — Glanders,  or  farcy,  is  a  very  fatal  contagious 
disease  of  horses  which  may  be  communicated  to  other  animals 
and  to  man.  The  cause  of  glanders  has  recently  been  discovered 
by  Loffler  to  be  a  bacillus  resembling  the  bacillus  tuberculosis. 
Pure  cultures  of  this  bacillus  were  inoculated  into  animals,  and 
followed  by  glanders  in  a  number  of  the  cases. 

The  infection  in  man  may  occur  either  upon  the  seat  of 


346  TEXT-BOOK   OF   HYGIENE. 

excoriations  of  the  skin  or  mucous  membranes,  especially  those 
of  the  nose,  conjunctiva,  and  possibly  by  inhalation  of  infective 
particles  floating  in  the  air. 

Animals  with  glanders  should  be  promptly  killed  and  their 
cadavers  cremated  or  deeply  buried.  No  part  of  the  body  of 
any  animal  dead  with  glanders  should  be  allowed  to  be  used. 
Infected  stables  should  be  thoroughly  disinfected. 

[The  works  of  especial  value  £o  students  who  desire  fuller 
information  upon  the  subjects  treated  in  this  chapter  are  the 
following : — 

Hirsch,  Handbuch  der  Historisck-Geograpkiscken  Patkologie,  2te 
Aufl.,  Stuttgart,  1883. — Hseser,  Gesckickteder  Epidemiscken  Krankkeiten. 
. — Hecker,  Tke  Black  Deatk,  translated  hy  B.  G.  Babington. — Defoe,  Jour- 
nal of  tke  Plague  in  London. — Roklfs,  Die  Orientaliscbe  Pest. — Marson, 
Small-pox,  in  Reynolds's  System  of  Medicine,  vol.  i. — Seaton,  Vaccina- 
tion, ibid. — Trousseau,  Clinical  Medicine,  vol.  i. — Fiftk  Annual  Report 
Illinois  State  Board  of  Health. — Harda way,  Essentials  of  Vaccination. — 
Crookskank,  History  and  Pathology  of  Vaccination. — Woodworth  and 
McClellan,  Cholera  Epidemic  in  United  States  in  1873. — Chaille,  Report 
of  Yellow  Fever  Commission,  Annual  Report  National  Board  of  Health  for 
1880. — Wood  and  Formad,  Memoir  on  the  Nature  of  Diphtheria,  ibid., 
1882. — Thompson,  Annals  of  Influenza. — Stille,  Epidemic  Meningitis. — 
Mueller,  Die  Venerischen  Krankheiten  im  Altherthum. — Lancereaux, 
Traite  de  la  Syphilis. — Bollinger,  Ueber  Menschen  u.  Thierpocken,  etc., 
Samml.  Klin.  Vortr.,  No.  116. — Ponfick,  Die  Actinomycose  des  Men- 
scken. — Gamgee,  Hydropkobia  and  Glanders,  in  Reynolds's  System  of 
Medicine,  vol.  i. — Bollinger,  Antkrax,in  Ziemssen's  Cj-clopaedia,  vol.  iii.] 


CHAPTER  XX. 

Antiseptics,  Disinfectants,  and  Deodorants. 

Much  confusion  exists  in  the  popular  mind,  and  even 
among  physicians,  as  to  the  exact  meaning  of  the  terms  at  the 
head  of  this  chapter.  By  many  they  are  used  synonymously,  and 
hence  frequently  give  rise  to  ambiguity  and  misunderstanding. 

Antisepsis,  which  is  so  frequently  confounded  with  disin- 
fection, should  be  more  accurately  defined  than  is  usual  by 
writers.  An  antiseptic  is  an  agent  which  retards,  prevents,  or 
arrests  putrefaction,  decay,  or  fermentation.  It  does  not  neces- 
sarily destroy  the  vitality  of  the  organisms  upon  which  these 
processes  depend.  An  antiseptic  may  also  arrest  the  develop- 
ment of  the  organisms  which  cause  infectious  diseases,  and  may 
hence  be  used  as  a  preventive  of  such  diseases.  But  antiseptics 
do  not  destroy  the  life  of  disease-germs,  and  hence  cannot  be 
relied  upon  when  such  organisms  are  present. 

By  disinfection,  in  the  proper  and  restricted  use  of  the  term, 
is  meant  the  destruction  of  the  specific  infectious  material  which 
causes  infectious  diseases.  If  the  view  is  accepted  that  all  in- 
fectious diseases  are  due  to  micro-organisms  or  germs,  then  a 
disinfectant  is  equivalent  to  a  germicide.  In  sanitary  practice 
and  experimental  investigations  this  view  is,  in  fact,  adopted. 
In  testing  the  action  of  various  disinfecting  agents  upon  infec- 
tious material,  the  biological  test  is  the  one  universally  relied 
upon  by  experimenters,  and  no  observations  upon  disinfection 
based  upon  chemical  tests  alone  would  be  accepted  by  sanitarians 
as  conclusive.  It  may  therefore  be  assumed  for  practical  pur- 
poses that  no  agent  can  be  accepted  as  a  disinfectant  if  it  is  not 
also  a  germicide.  From  this  it  follows  that  disinfection,  to  be 
trustworthy,  must  be  thorough.  "  There  can  be  no  partial 
disinfection  of  infectious  material ;  either  its  infectious  power  is 
destroyed,  or  it  is  not.  In  the  latter  case  there  is  a  failure  to 
disinfect."1     Obviously,  also,  there  can  be  no  disinfection  in  the 

1  Report  of  Committee  on  Disinfectants  of  the  American  Public  Health  Association, p.  236. 

(347) 


348 


TEXT-BOOK    OF    HYGIENE. 


absence  of  infectious  material.  Faecal  discharges,  a  diseased 
body  or  corpse,  clothing,  bedding,  an  apartment,  a  ship,  or  a 
hospital  ward  may  or  may  not  be  infected.  In  the  former  case 
we  may  speak  of  disinfecting  them ;  in  the  latter,  it  would  be  an 
inappropriate  use  of  the  word. 

Confusion  is  also  liable  to  arise  by  considering  disinfectants 
and  deodorizers  as  synonymous.  Deodorants  merely  remove 
offensive  odors,  and  may  not  possess  any  disinfecting  power 
whatever.  Thus,  one  of  the  most  efficient  disinfectants  at  our 
command  (mercuric  chloride)  is  not  a  deodorizer  at  all,  except 
by  preventing  putrefaction.  On  the  other  hand,  some  of  the 
most  effective  deodorants  have  only  a  subordinate  position  in  the 
scale  of  disinfectants. 

Careful  investigations  have  shown  that  there  is  a  wide 
divergence  between  various  disinfecting  agents  in  their  influence 
upon  disease-germs,  some  being  efficient  in  high  dilutions,  while 
others  require  to  be  brought  in  contact  with  the  germs  in  great 
concentration.  For  example,  mercuric  chloride  will  act  as  an 
efficient  poison  to  certain  disease-germs  (anthrax  spores)  in  the 
proportion  of  1  to  1000,  while  zinc-chloride  must  be  used  in  the 
proportion  of  1  to  5  (or  20  per  cent.). 

It  has  been,  further,  discovered  that  different  disease-germs 

present  varying  resisting  power  to  the  same  disinfecting  agent, 

some  being  easily  destroyed,  while  others  are  much  more  resistant. 

For  example,  the  following  table  shows  a  number  of  experiments 

made  by  Dr.  Meade  Bolton  for  the  American  Committee  on 

Disinfectants  : — 

Table  XXYII. 


Organism. 

Chloride  of 
Lime. 

Mercuric 
Chloride. 

Carbolic  Acid. 

Cholera  spirillum      .... 

Staphylococcus  aureus .     .     . 
Stapii3'lococcus  citreus       .     . 
Staphylococcus  albus     .     .     . 

1  :  2000 
1  :  2000 
1:100 

1:200 
1  :50 

1:200 

1  :  10,000 
1:10,000 
1:1000 

1:100 
1:100 

1:50 
(Uncerfain.) 
1:100 
1:100 
1:100 

ANTISEPTICS,    DISINFECTANTS,    AND    DEODORANTS.  349 

Assuming  that  infectious  diseases  are  caused  by  micro- 
organisms, and  that  these  are  different  from  the  micro-organisms 
of  ordinary  decay  or  putrefaction,  it  can  be  readily  understood 
that  the  processes  of  organic  decomposition  may  themselves  act 
as  disinfectants.  It  is  known,  for  example,  that  when  a  fer- 
menting liquid  putrefies,  the  organisms  of  fermentation  disap- 
pear and  give  place  to  the  organisms  of  putrefaction  (bacterium 
termo,  etc.).  So,  likewise,  the  bacilli  of  anthrax  and  of  tuber- 
culosis are  killed  by  the  putrefactive  process,  if  this  takes  place 
in  the  absence  of  free  oxygen.  Furthermore,  the  reproduction 
of  organisms  of  a  certain  kind  ceases  when  certain  chemical  (?) 
changes  take  place  in  their  environment.  Fermentation  in  a 
saccharine  liquid  ceases  and  the  ferment-organisms  die  when  the 
accumulation  of  the  product  of  the  fermentation  (alcohol)  has 
reached  a  certain  proportion,  although  there  may  still  be  un- 
decomposed  sugar  present.  In  like  manner  it  is  intelligible  that 
the  products  of  micro-organisms  may  eventually  destroy  their 
producers,  and  so  place  a  limit  to  the  morbid  process.  The 
specific  cause  of  small-pox,  yellow  fever,  cholera,  and  similar 
infectious  diseases  is  rapidly  destroyed  when  decomposition  of 
the  corpses  of  those  dead  with  such  diseases  sets  in.  Hence, 
the  reason  why  infectious  diseases  are  not  spread  from  cemeteries. 

From  the  foregoing  it  may  be  gathered  that  disinfection 
consists  chiefly  in  a  struggle  against  organized  disease-germs.1 
As,  however,  experiments  and  observations  have  shown  that  the 
life-history  of  disease-germs  varies  with  the  different  organisms 
involved,  it  becomes  evident  that  specific  directions  concerning 
disinfection  can  be  given  only  when  the  life-history  of  the 
specific  organism  is  known. 

The  American  Committee  on  Disinfectants,  to  wThose  work 
reference  has  already  been  made,  divides  disinfectants  into  two 
classes :  those  efficient  for  the  destruction  of  infectious  material 
containing  spores,  and  those  which  will  destroy  infectious  ma- 
terial only  in  the  absence  of  spores.     The  recommendations  of 

i  Mueller  una  Falk,  in  Realencyclopsedie  d.  ges.  Heilk.,  Bd.  IV.,  p.  62. 


350  TEXT-BOOK   OF   HYGIENE. 

the  committee,  covering  not  only  the  appropriate  disinfectant  to 
be  used  for  the  destruction  of  the  organisms,  but  also  the  con- 
ditions under  which  the  agent  should  be  used,  are  as  follow : — 

The  most  useful  agents  for  the  destruction  of  spore-containing 
infectious  material  are  : — 

1.  Fire.     Complete  destruction  by  burning. 

2.  Steam  under  pressure.     105°  C.  (221°  F.)  for  ten  minutes. 

3.  Boiling  in  water  for  half  an  hour. 

4.  Chlorinated  lime.1     A  4-per-cent.  solution. 

5.  Mercuric  chloride.     A  solution  of  1  to  500. 

For  the  destruction  of  infectious  material  which  owes  its  infecting 
power  to  the  presence  of  micro-organisms  not  containing  spores,  the 
committee  recommends  : — 

1.  Fire.  Complete  destruction  by  burning. 

2.  Boiling  in  water  for  ten  minutes. 

3.  Dry  heat.     110°  C.  (230°  F.)  for  two  hours. 

4.  Chlorinated  lime.1     A  2-per-cent.  solution. 

5.  Solution  of  chlorinated  soda.2     A  10-per-cent.  solution. 

6.  Mercuric  chloride.     A  solution  of  1  to  2000. 

7.  Sulphur  dioxide.  Exposure  for  twelve  hours  to  an  atmosphere 
containing  at  least  4  volumes  per  cent,  of  this  gas  in  presence  of 
moisture.3 

8.  Carbolic  acid.     A  5-per-cent.  solution. 

9.  Suljihate  of  copper.     A  5-per-cent.  solution. 
10.   Chloride  of  zinc.     A  10-per-cent.  solution. 

The  committee  would  make  the  following  recommendations  with 
reference  to  the  practical  application  of  these  agents  for  disinfecting 
purposes : — 

For  Excreta. 

(a)  In  the  sick-room  : — 

1.  Chlorinated  lime  in  solution,  4  per  cent. 
In  the  absence  of  spores  : — 

2.  Carbolic  acid  in  solution,  5  per  cent. 

3.  Sulphate  of  copper  in  solution,  5  per  cent. 
(6)  In  privy-vaults  : — 

1.  Mercuric  chloride  in  solution,  1  to  500. 4 

2.  Carbolic  acid  in  solution,  5  per  cent. 

1  Should  contain  at  least  25  per  cent,  of  available  chlorine. 

2  Should  contain  at  least  3  per  cent,  of  available  chlorine. 

3  This  will  require  the  combustion  of  between  1%  to  2  kilogrammes  of  sulphur  for  every 
28  cubic  metres  of  air-space. 

4  The  addition  of  an  equal  quantity  of  potassium  permanganate  as  a  deodorant,  and  to 
give  color  to  the  solution,  is  to  be  recommended. 


ANTISEPTICS,    DISINFECTANTS,    AND    DEODORANTS.  351 

(c)  For  the  disinfection  and  deodorization  of  the  surface  of  masses 
of  organic  material  in  privy-vaults   etc.: — 
Chlorinated  lime  in  powder. 

For  Clothing,  Bedding,  etc. 

(a)  Soiled  underclothing,  bed-linen,  etc.: — 

1.  Destruction  by  fire,  if  of  little  value. 

2.  Boiling  for  at  least  half  an  hour. 

3.  Immersion  in  a  solution  of  mercuric  chloride  of  the  strength 
of  1  to  2000  for  four  hours. 

4.  Immersion  in  a  2-per-cent.  solution  of  carbolic  acid  for  four 
hours. 

(6)  Outer  garments  of  wool  or  silk,  and  similar  articles,  which 
would  be  injured  by  immersion  in  boiling  water  or  in  a  disinfecting 
solution : — 

1.  Exposure  in  a  suitable  apparatus  to  a  current  of  steam  for 
ten  minutes. 

2.  Exposure  to  dry  heat  at  a  temperature  of  110°  C.  (230°  F.) 
for  two  hours. 

(c)  Mattresses  and  blankets  soiled  by  the  discharges  of  the  sick : — 

1.  Destruction  by  fire. 

2.  Exposure  to  superheated  steam  (105°  C.  =  221°  F.)  for  ten 
minutes.  (Mattresses  to  have  the  cover  removed  or  freely 
opened.) 

3.  Immersion  in  boiling  water  for  half  an  hour. 

Furniture  and  Articles  op  "Wood,  Leather,  and  Porcelain. 

Washing,  several  times  repeated,  with  solution  of  carbolic  acid,  2 
per  cent. 

For  the  Person. 

The  hands  and  general  surface  of  the  body  of  attendants  of  the 
sick,  and  of  the  convalescents,  should  be  washed  with — 

1.  Solution  of  chlorinated  soda  diluted  with  nine  parts  of 
water  (1  to  10). 

2.  Carbolic  acid,  2-per-cent.  solution. 

3.  Mercuric  chloride,  1  to  1000. 

For  the  Dead. 
Envelop  the  body  in  a  sheet  thoroughly  saturated  with — 

1.  Chlorinated  lime  in  solution,  4  per  cent. 

2.  Mercuric  chloride  in  solution,  1  to  500. 

3.  Carbolic  acid  in  solution,  5  per  cent. 


352  TEXT-BOOK    OF   HYGIENE. 

For  the  Sick-room  and  Hospital  Wards. 

(a)  "While  occupied,  wash  all  surfaces  with — 

1.  Mercuric  chloride  in  solution.  1  to  1000. 

2.  Carbolic  acid  in  solution,  2  per  cent. 
(6)  When  vacated  : — 

Fumigate  with  sulphur  dioxide  for  twelve  hours,  burning  at  least  1^ 
kilogrammes  sulphur  for  ever}"  28  cubic  metres  of  air-space  in  the  room ; 
then  wash  all  surfaces  with  one  of  the  above-mentioned  disinfecting 
solutions,  and  afterward  with  soap  and  hot  water  ;  finally  throw  open 
doors  and  windows  and  ventilate  freeby. 

For  Merchandise  and  the  Mails. 

The  disinfection  of  merchandise  and  of  the  mails  will  only  be 
required  under  exceptional  circumstances  ;  free  aeration  will  usually  be 
sufficient.  If  disinfection  seems  necessary,  fumigation  with  sulphur 
dioxide  will  be  the  only  practicable  method  of  accomplishing  it  without 

injury. 

Rags. 

(a)  Rags  which  have  been  used  for  wiping  away  infectious  discharges 
should  at'once  be  burned. 

(b)  Rags  collected  for  the  paper-makers  during  the  prevalence  of 
an  epidemic  should  be  disinfected,  before  they  are  compressed  in  bales, 

by— 

1.  Exposure  to  superheated  steam  (105°  C.=  221°  F.)  for  ten 

minutes. 

2.  Immersion  in  boiling  water  for  half  an  hour. 

Ships. 
(a)  Infected  ships  at  sea  should  be  washed  in  every  accessible  place, 
and  especially  localities  occupied  b}T  the  sick,  with — 

1.  Solution  of  mercuric  chloride,  1  to  1000. 

2.  Solution  of  carbolic  acid,  2  per  cent. 

The  bilge  should  be  disinfected  b}-  the  liberal  use  of  a  strong 
solution  of  mercuric  chloride. 
(6)  Upon  arrival  at  a  quarantine  station,  an  infected  ship  should  at 
once  be  fumigated  with  sulphurous-acid  gas.  using  H  kilogrammes  of 
sulphur  for  ever}'  28  cubic  metres  of  air-space ;  the  cargo  should  then 
be  discharged  on  lighters  ;  a  liberal  supply  of  the  concentrated  solution 
of  mercuric  chloride  (1  to  32)  should  be  thrown  into  the  bilge,  and  at  the 
end  of  twenty-four  hours  the  bilge-water  should  be  pumped  out  and 
replaced  with  pure  sea- water ;  this  should  be  repeated.  A  second  fumi- 
gation after  the  removal  of  the  cargo  is  recommended.     All  accessible 


ANTISEPTICS,    DISINFECTANTS,    AND    DEODORANTS.  353 

surfaces  should  be  washed  with  one  of   the  disinfecting  solutions  here- 
tofore recommended,  and  subsequently  with  soap  and  hot  water. 

For  Railway-cars. 
The  directions  given  for  the  disinfection  of  dwellings,  hospital 
wards,  and  ships  apply  as  well  to  infected  railway-cars.  The  treatment 
of  excreta  with  a  disinfectant  before  they  are  scattered  along  the  tracks 
seems  desirable  at  all  times,  in  view  of  the  fact  that  the}'  may  contain 
infectious  germs.  During  the  prevalence  of  an  epidemic  of  cholera  this 
is  imperative.  For  this  purpose  the  standard  solution  of  chlorinated 
lime  is  recommended. 

From  the  foregoing  it  would  appear  that  heat,  chlorinated 
lime,  mercuric  chloride,  solution  of  chlorinated  soda  (Labar- 
raque's  solution),  carbolic  acid,  sulphate  of  copper,  zinc  chloride, 
and  sulphur  dioxide  (sulphur- fumes)  are  the  most  generally 
available  disinfectants. 

The  following  "  general  directions  "  for  the  practical  appli- 
cation of  disinfection  are  given  by  the  committee : — 

Disinfection  of  Excreta,  etc. — The  infectious  character  of  the  dejec- 
tions of  patients  suffering  from  cholera  and  typhoid  fever  is  well  estab- 
lished ;  and  this  is  true  of  mild  cases  and  of  the  earliest  stages  of  these 
diseases,  as  well  as  of  severe  and  fatal  cases.  It  is  probable  that  epidemic 
dysentery,  tuberculosis,  and  perhaps  diphtheria,  yellow  fever,  scarlet 
fever,  and  typhus  fever  may  also  be  transmitted  b}'  means  of  the  alvine 
discharges  of  the  sick.  It  is,  therefore,  of  the  first  importance  that  these 
should  be  disinfected.  In  cholera,  diphtheria,  3'ellow  fever,  and  scarlet 
fever  all  vomited  material  should  also  be  looked  upon  as  infectious. 
And  in  tuberculosis,  diphtheria,  scarlet  fever,  and  infectious  pneumonia 
the  sputa  of  the  sick  should  be  disinfected  or  destroyed  by  fire.  It  seems 
advisable,  also,  to  treat  the  urine  of  patients  sick  with  an  infectious 
disease  with  one  of  the  disinfecting  solutions  below  recommended. 

Chloride  of  lime,  or  bleaching  powder,  is  perhaps  entitled  to  the  first 
place  for  disinfecting  excreta,  on  account  of  the  rapidity  of  its  action. 
The  following  standard  solution  is  recommended  : — 

Dissolve  chloride  of  lime  {chlorinated  lime,  bleaching  powder)  of  the 
best  quality1  in  pure  water  in  the  proportion  of  6  ounces  to  the  gallon 
(45  grammes  to  the  litre). 

Use  1  quart  (1  litre)  of  this  solution  for  the  disinfection  of  each  dis- 
charge in  cholera,  typhoid  fever,  etci2     Mix  well,  and  leave  in  the  vessel 

1  Good  chloride  of  lime  should  contain  at  least  25  per  cent,  of  available  chlorine. 

2  For  a  very  copious  discharge  use  a  larger  quantity. 

23 


354  TEXT-BOOK   OF   HYGIENE. 

for  at  least  one  hour  before  throwing  into  privy-well  or  water-closet. 
The  same  directions  appty  for  the  disinfection  of  vomited  matters. 
Infected  sputum  should  be  discharged  directly  into  a  cup  half  full  of  the 
solution.1  A  5-per-cent.  solution  of  carbolic  acid  may  be  used  instead 
of  the  chloride-of-lime  solution,  the  time  of  exposure  to  the  action  of  the 
disinfectant  being  four  hours. 

Disinfection  of  the  Person. — The  surface  of  the  body  of  a  sick  person 
or  of  his  attendants,  when  soiled  with  infectious  discharges,  should  be  at 
once  cleansed  with  a  suitable  disinfecting  agent.  For  this  purpose,  solu- 
tion of  chlorinated  soda  (liquor  sodse  chlorinatse — Labarraque's  solution) 
diluted  with  9  parts  of  water,  or  the  standard  solution  of  chloride  of  lime 
diluted  with  3  parts  of  water,  may  be  used.  A  2-per-cent.  solution  of 
carbolic  acid  is  also  suitable  for  this  purpose,  and  under  proper  medical 
supervision  the  use  of  a  solution  of  corrosive  sublimate  (1  to  1000)  is  to 
be  recommended. 

In  diseases  like  small-pox  and  scarlet  fever,  in  which  the  infectious 
agent  is  given  off  from  the  entire  surface  of  the  bocby,  occasional  ablu- 
tions with  the  above-mentioned  solution  of  chlorinated  soda  are  recom- 
mended. 

In  all  infectious  diseases  the  body  of  the  dead  should  be  enveloped 
in  a  sheet  saturated  with  the  standard  solution  of  chlorinated  lime,  or 
with  a  5-per-cent.  solution  of  carbolic  acid,  or  a  1  to  500  solution  of  cor- 
rosive sublimate. 

Disinfection  of  Clothing. — Boiling  for  half  an  hour  will  destroy  the 
vitalit}^  of  all  known  disease-germs,  and  there  is  no  better  way  of  dis- 
infecting clothing  or  bedding  which  can  be  washed  than  to  put  it 
through  the  ordinal-}'  operations  of  the  laundry.  No  dela}r  should  occur, 
however,  between  the  time  of  removing  soiled  clothing  from  the  person 
or  bed  of  the  sick  and  its  immersion  in  boiling  water,  or  in  one  of  the 
following  solutions  until  this  can  be  done  : — 

Corrosive  sublimate,  1  gramme  to  the  litre  (1  to  1000),  or  carbolic 
acid  (pure),  8  grammes  to  the  litre. 

The  articles  to  be  disinfected  must  be  thoroughly  soaked  with  the 
disinfecting  solution  and  left  in  it  for  at  least  two  hours,  after  which  they 
may  be  wrung  out  and  sent  to  the  wash.2 

Clothing  or  bedding  which  cannot  be  washed  should  be  disinfected 

'Recently  a  small  spitting-cup  made  of  stiff  paper  has  been  introduced  especially  for  tlie 
use  of  consumptives.  The  cup  is  carried  about  by  the  patient  or  kept  within  reach.  When  the 
cup  has  been  in  use  for  a  time,  and  before  the  sputa  can  become  desiccated,  it  is  thrown  into  the 
fire  and  burned. 

2  Solutions  of  corrosive  sublimate  should  not  be  placed  in  metal  receptacles,  for  the  salt  is 
decomposed  and  the  mercury  precipitated  by  contact  with  copper,  lead,  or  tin.  A  wooden  tub 
or  earthen  crock  is  a  suitable  receptacle  for  such  solutions. 


ANTISEPTICS,    DISINFECTANTS,    AND    DEODORANTS.  355 

by  steam  in  a  property-constructed  disinfection  chamber.  In  the  absence 
of  a  suitable  steam  disinfecting  apparatus,  infected  clothing  and  bedding 
should  be  burned. 

Disinfection  of  the  Sick-room. — In  the  sick-room  no  disinfectant  can 
take  the  place  of  free  ventilation  and  cleanliness.  It  is  an  axiom  in  sani- 
tary science  that  it  is  impracticable  to  disinfect  an  occupied  apartment 
for  the  reason  that  disease-germs  are  not  destroyed  by  the  presence  in 
the  atmosphere  of  any  known  disinfectant  in  respirable  quantity.  Bad 
odors  may  be  neutralized,  but  this  does  not  constitute  disinfection  in  the 
sense  in  which  the  term  is  here  used.  These  bad  odors  are,  for  the  most 
part,  an  indication  of  want  of  cleanliness  or  of  proper  ventilation,  and  it 
is  better  to  turn  contaminated  air  out  of  the  window  or  up  the  chimney 
than  to  attempt  to  purify  it  by  the  use  of  volatile  chemical  agents,  such 
as  carbolic  acid,  chlorine,  etc.,  which  are  all  more  or  less  .offensive  to  the 
sick,  and  are  useless  so  far  as  disinfection — properly  so  called — is  con- 
cerned. 

When  an  apartment  which  has  been  occupied  by  a  person  sick  with 
an  infectious  disease  has  been  vacated,  it  should  be  disinfected.  The 
object  of  disinfection  in  the  sick-room  is  mainly  the  destruction  of  infec- 
tious material  attached  to  surfaces  or  deposited  as  dust  upon  window- 
ledges,  in  crevices,  etc.  If  the  room  has  been  properly  cleansed  and 
ventilated  while  still  occupied  by  the  sick  person,  and  especially  if  it 
was  stripped  of  carpets  and  unnecessar}^  furniture  at  the  outset  of  his 
attack,  the  difficulties  of  disinfection  will  be  greatly  reduced. 

All  surfaces  should  be  thoroughly  washed  with  the  standard  solu- 
tion of  chloride  of  lime,  diluted  with  3  parts  of  water,  or  with  1  to  1000 
solution  of  corrosive  sublimate.  The  walls  *and  ceiling,  if  plastered, 
should  be  subsequently  treated  with  a  lime-wash.  Especial  care  must 
be  taken  to  wash  away  all  dust  from  window-ledges  and  other  places 
where  it  may  have  settled,  and  thoroughly  to  cleanse  crevices  and  out- 
of-the-way  places.  After  this  application  of  the  disinfecting  solution, 
and  an  interval  of  twentj'-four  hours  or  longer  for  free  ventilation,  the 
floors  and  wood-work  should  be  well  scrubbed  with  soap  and  hot  water, 
and  this  should  be  followed  by  a  second,  more  prolonged  exposure  to 
fresh  air,  admitted  through  open  doors  and  windows. 

As  an  additional  precaution,  fumigation  with  sulphurous-acid  gas  is 
to  be  recommended,  especially  for  rooms  which  have  been  occupied  by 
patients  with  small-pox,  scarlet  fever,  diphtheria,  typhus  fever  and  yel- 
low fever.  But  fumigation  with  sulphurous-acid  gas  alone,  as  commonly 
practiced,  cannot  be  relied  upon  for  disinfection  of  the  sick-room  and  its 
contents,  including  bedding,  furniture,  infected  clothing,  etc.,  as  is  popu- 
larly believed. 


356  TEXT-BOOK    OF    HYGIENE. 

When  fumigation  is  practiced,  it  should  precede  the  general  washing 
with  a  disinfecting  solution  heretofore  recommended.  To  insure  any 
results  of  Talue,  it  will  be  necessary  to  close  the  apartment  to  be  disin- 
fected as  completely  as  possible  hy  stopping  up  all  apertures  through 
which  the  gas  might  escape,  and  to  burn  not  less  than  3  pounds  of 
sulphur  for  each  1000  cubic  feet  (1^  kilogrammes  to  28  cubic  metres)  of 
air-space  in  the  room.  To  secure  complete  combustion  of  the  sulphur, 
it  should  be  placed,  in  the  form  of  powder  or  small  fragments,  into  a 
shallow  iron  pan,  which  should  be  set  upon  a  couple  of  bricks  in  a  tub 
partly  filled  with  water,  to  guard  against  fire.  The  sulphur  should  be 
thoroughly  moistened  with  alcohol  before  igniting  it. 

Disinfection  of  Privy-vaults,  Cess-pools,  etc. — When  the  excreta 
(not  previously  disinfected)  of  patients  with  cholera  or  typhoid  fever 
have  been  thrown  into  a  privy-vault  this  is  infected,  and  disinfection 
should  be  resorted  to  as  soon  as  the  fact  is  discovered,  or  whenever  there 
is  reasonable  suspicion  that  such  is  the  case.  It  will  be  advisable  to  take 
the  same  precautions  with  reference  to  privy-vaults  into  which  the  ex- 
creta of  yellow  fever  have  been  thrown,  although  we  do  not  definitely 
know  that  this  is  infectious  material. 

For  this  purpose  the  standard  solution  of  chloride  of  lime  may  be 
used  in  quantity  proportioned  to  the  amount  of  material  to  be  disin- 
fected, but  where  this  is  considerable  it  will  scarcely  be  practicable  to 
sterilize  the  whole  mass.  The  liberal  and  repeated  use  of  this  solution, 
or  of  a  5-per-cent.  solution  of  carbolic  acid,  will,  however,  disinfect  the 
surface  of  the  mass,  and  is  especial^  to  be  recommended  during  the  epi- 
demic prevalence  of  typhoid  fever  or  of  cholera. 

All  exposed  portions  of  the  vault,  and  the  wood-work  above  it, 
should  be  thoroughly  washed  down  with  the  disinfecting  solution.  In- 
stead of  the  disinfecting  solutions  recommended,  chloride  of  lime  in 
powder  may  be  daily  scattered  over  the  contents  of  the  privy-vault. 

Disinfection  of  Ingesta. — It  is  well  established  that  cholera  and 
typhoid  fever  are  very  frequently,  and  perhaps,  usually,  transmitted 
through  the  medium  of  infected  water  or  articles  of  food,  and  especially 
milk.  Fortunately,  we  have  a  simple  means  at  hand  for  disinfecting  such 
infected  fluid.  This  consists  in  the  application  of  heat.  The  boiling 
temperature  maintained  for  half  an  hour  kills  all  known  disease-germs. 
So  far  as  the  germs  of  cholera,  yellow  fever,  and  diphtheria  are  concerned, 
there  is  good  reason  to  believe  that  a  temperature  considerably  below 
the  boiling-point  of  water  will  destroy  them.  But  in  order  to  keep  on 
the  safe  side,  it  is  best  not  to  trust  anything  short  of  the  boiling-point 
(100°  C.  =  212°  F.)  when  the  object  is  to  disinfect  food  or  drink  which  is 
open  to  the  suspicion  of  containing  the  germs  of  any  infectious  disease. 


ANTISEPTICS,    DISINFECTANTS,    AND    DEODORANTS. 


357 


During  the  prevalence  of  an  epidemic  of  cholera  it  is  well  to  boil  all 
■water  for  drinking  purposes.  After  boiling,  the  "water  may  be  filtered, 
if  necessary,  to  remove  sediment,  and  then  cooled  with  pure  ice  if 
desired. 

The  following  substances  are  antiseptics,  but  in  the 
strength  given  cannot  be  depended  upon  as  disinfectants : — 


Table  XXVIII. 

Thymol, 

Bichloride  of  mercury, 

Oil  of  mustard, 

Acetate  of  alumina, 

Bromine, 

Picric  acid,     . 

Iodine,    . 

Sulphuric  aeid, 

Permanganate  of  potassium, 

Camphor, 

Eucalyptol,     . 

Chromic  acid, 

Chloride  of  aluminum, 

Hydrochloric  acid, 

Benzoic  acid, 

Quinine, 

Boric  acid, 

Salicylic  acid, 

Carbolic  acid, 

Sulphate  of  copper, 

Nitric  acid,     . 

Biborate  of  soda,    . 

Sulphate  of  iron,    . 

Creasote, 

Arsenious  aeid, 

Pyrogallic  acid, 

Tr.  chloride  of  iron, 

Alcohol, 


1:800 


1:80,000. 
40,000. 
33,000. 
6310. 
5597. 
5000. 
4000. 
3353. 
3000. 
2500. 
2500. 
2200. 
2000. 
1700. 
1439. 
1000. 


1:200-1:800. 
1  j  200-1:  800. 
1  :  500. 


400. 

400. 

200. 

200. 

200. 

100. 

62. 

25. 


40  to  95  per  cent. 

The  agents  mentioned  in  the  above  list  may  all  be  used 
with  satisfactory  results  in  surgical  and  obstetrical  practice  as 
antiseptics,  but  it  must  be  borne  in  mind  that  the  great  danger 
in  treating  wTounds  comes  from  carrying  infectious  particles  to 
them  in  the  hands  or  instruments  of  the  operator.     In  order  to 


358  TEXT-BOOK    OF    HYGIENE. 

render  these  aseptic  the  most  thorough  measures  of  disinfection, 
such  as  heat,  strong  chemical  disinfectants,  and  physical  as  well 
as  chemical  and  biological  cleanliness  are  indicated.  In  a  sur- 
gical wound,  or  in  the  vagina  and  uterus  of  the  parturient 
woman,  the  use  of  antiseptics  is  entirely  secondary  to  disinfec- 
tion, under  which  may  primarily  be  understood  rigid  cleanliness. 

In  public  and  private  sanitation,  antiseptics  have,  as  in 
practical  surgery,  a  subordinate  importance. 

Deodorizers  are  sometimes  useful  in  sanitary  practice,  but 
care  must  be  taken  not  to  look  upon  deodorization  as  equiva- 
lent to  disinfection.  Among  the  most  useful  deodorizers  are 
chloride  of  zinc,  chloride  of  lime,  permanganate  of  potassium, 
and  a  number  of  the  agents  mentioned  in  Table  XXVIII. 


"*3* 


[The  following  additional  works  are  recommended  for 
study  in  connection  with  this  chapter : — 

Sternberg  and  Magnin,  The  Bacteria,  2d  ed. — Fluegge,  Fermente 
nnd  Mikroparasiten,  in  von  Pettenkofer  und  Ziemssen's  Handb.  d. 
Hygiene,  I  Th.,  2  Abth.,  1  Hft. — Wernich,  Desinfectionslehre  zum  prak- 
tischen  Grebrauch. — Tallin.  Traite  des  Disinfectants  et  de  la  Disinfection. 
— Final  Report  of  the  Committee  on  Disinfectants  of  the  American 
Public  Health  Association. — Sternberg,  Disinfection  and  Personal 
Prophylaxis   Lornb  Prize  Essay.  1886.] 


CHAPTER  XXL 

Vital  Statistics. 

The  registration  of  vital  statistics  comprises  the  recording 
of  the  births,  marriages,  deaths,  and  diseases  of  a  city,  State,  or 
nation.  In  no  other  way  can  a  knowledge  of  the  health  of  the 
inhabitants  of  such  communities  be  obtained.  For  smaller,  or 
special  communities,  such  as  armies,  navies,  schools,  or  special 
classes  of  workmen,  the  health  status  may  be  ascertained  by 
direct  methods ;  but  for  larger  communities  this  is  clearly 
impracticable,  and  the  sanitarian  is  obliged  to  depend  upon  the 
census  and  the  registration  of  births,  marriages,  and  deaths. 

From  a  sanitary  point  of  view,  the  most  important  object 
of  a  registration  of  vital  statistics  is  to  "  give  warning  of  the 
undue  increase  of  disease  or  death  presumed  to  be  due  to 
preventable  causes,  and  also  to  indicate  the  localities  in  which 
sanitary  effort  is  most  desirable  and  most  likely  to  be  of  use."  * 

The  duty  of  registration  should  devolve  upon  the  sanitary 
administration.  Local  and  State  boards  of  health  would  seem 
to  be  the  most  appropriate  media  for  collecting  information  bear- 
ing upon  births,  diseases,  and  deaths.  It  would  seem  also  to 
be  most  appropriate  to  require  the  attending  physicians  to  make 
reports  of  deaths  and  of  cases  of  contagious  diseases  to  the 
health  authorities. 

REGISTRATION    OF    DEATHS. 

The  data  entered  upon  the  record  of  death  should  com- 
prise the  name,  age,  sex,  color,  nativity,  descent,  occupation, 
and  civil  condition  of  decedent,  with  date,  place,  and  cause  of 
death.  Under  the  heading  "  Descent,"  the  birthplace  of  each 
parent    should    be    given.     Occupation     should    be    accurately 

•J.  S.  Billings,  Registration  of  Vital  Statistics,  Am.  Jour  Med.  Sciences,  voL 
lxxxv,  p.  37. 

(359) 


360  TEXT-BOOK   OF   HYGIENE. 

specified.  The  place  of  death  should  indicate  the  exact  locality 
(number  of  street)  where  it  occurred.  Both  proximate  and 
predisposing  causes  of  death  should  be  entered,  and  any  com- 
plications which  may  have  influenced  the  fatal  termination 
should  be  noted  on  the  record. 

This  record  should  be  in  the  possession  of  the  local  health 
authority  before  a  permit  for  the  burial  of  the  deceased  is 
granted.  If  this  is  not  insisted  upon,  the  report  will  soon  be 
omitted  and  the  registration  become  defective. 

REGISTRATION    OF   BIRTHS. 

The  collection  of  data  for  an  accurate  registration  of  births 
is  much  more  difficult  than  the  record  of  deaths.  Instead  of 
requiring  physicians  and  midwives  in  attendance  at  the  confine- 
ment to  report  births,  it  would  be  more  equitable  and  probably 
more  effectual  to  compel  the  parents,  under  a  penalty  for  failure, 
to  record  the  birth  of  each  child  at  the  board  of  health.  The 
items  usually  included  in  birth  returns  are :  date  and  place  of 
birth,  sex  and  color  of  child,  names  of  father  and  mother, 
parents'  nativity  and  age,  and  father's  occupation.  Sometimes 
the  residence  of  the  mother,  number  of  children  previously 
borne  by  the  same  mother,  whether  the  child  is  legitimate  or 
not,  and  various  other  details  are  also  added.  It  is  evident  that 
for  sanitary  purposes  most  of  this  information  is  entirely  irrele- 
vant. It  seems  to  the  author  that,  for  the  purpose  of  the  sani- 
tarian and  medical  statistician,  the  date  and  place  of  birth,  sex 
and  color  of  the  child,  and  age,  nativity,  and  occupation  of 
both  parents  are  sufficient. 

REGISTRATION   OF    MARRIAGES. 

The  record  of  marriages  is  of  no  interest  to  the  sanitarian. 
If,  however,  the  registration  could  be  made  by  a  competent 
medical  man,  and  the  physical  condition  of  the  contracting  par- 
ties noted,  valuable  deductions  might  be  made  in  time,  especially 
if  the  parties  themselves  and  their  offspring  could  be  kept  under 


VITAL    STATISTICS.  361 

observation  for  many  years.     This,  however,  is  so  manifestly 
impracticable  that  it  barely  deserves  notice  in  this  place. 

REGISTRATION    OF   DISEASES. 

As  has  been  seen  in  Chapter  XIX,  a  large  class  of  diseases 
are  communicable  from  one  individual  to  another,  either 
directly,  by  contact,  or  mediately,  by  infection.  In  large  com- 
munities it  is  therefore  important  that  the  sanitary  authorities 
should  possess  information  of  the  presence  and  prevalence  of 
these  diseases,  in  order  that  measures  may  be  instituted  for  their 
restriction.  It  is  true  that  in  most  cases  the  registration  of 
deaths  gives  but  too  mournful  evidence  of  the  more  fatal  of  the 
diseases  of  this  class,  but  destructive  epidemics  could  probably 
be  frequently  averted  if  preventive  measures  could  be  enforced 
early.  Besides,  in  the  case  of  dengue  and  epidemic  influenza, 
the  death-rate  is  so  small  that,  if  the  registration  of  deaths  were 
alone  depended  upon,  no  evidence  whatever  might  be  attain- 
able of  the  epidemic  prevalence  of  such  diseases. 

The  registration  of  prevailing  diseases  is,  therefore,  one  of 
•the  most  important  duties  of  the  registrar  of  vital  statistics. 
Prompt  notice  of  all  cases  of  infectious,  miasmatic,  or  contagious 
diseases  coming  under  their  professional  notice  should  be  required 
of  all  physicians.  It  is  unquestionably  just,  however,  that  the 
physicians  required  to  perform  this  duty  should  be  properly  com- 
pensated by  the  public,  whose  interests  they  serve. 

DEATH-RATE  AND  BIRTH-RATE. 

In  order  to  calculate  the  annual  death-rate  of  a  place,  two 
facts  are  required  to  be  known :  first,  the  actual  or  estimated 
population  (generally  obtained  from  the  census),  and,  second, 
the  number %of  persons  who  died  within  the  district.  The  num- 
ber of  deaths  is  then  divided  by  the  population,  which  gives  the 
death-rate  for  each  individual  for  the  year.  To  find  the  death- 
rate  per  1000,  the  death-rate  as  found  above  is  multiplied  by 
1000.     Thus,  the  total  number  of  deaths  in  the  city  of  Baltimore 


362  TEXT-BOOK   OF    HYGIENE. 

during  1883  was  9380,  and  the  estimated  population  408,520. 
The  death-rate  for  the  year  was  22.96  per  1000,  obtained  as 

follows : — 

9380  X  1000 

. =  22  96  ner  M. 

408,520  ! 

To  calculate  the  annual  death-rate  of  a  place  for  each  1000 
of  the  population  from  the  returns  for  one  week,  the  weekly 
population  for  the  place  is  first  ascertained,  and  then  the  total 
number  of  deaths  for  the  week  divided  by  the  weekly  popula- 
tion, and  the  quotient  multiplied  by  1000.  The  following  con- 
crete example  will  render  this  clear  : — 

The  exact  number  of  weeks  in  a  year  is  52.17747.  The 
total  population  is  divided  by  this  figure,  giving  the  weekly 
population.  This  gives  for  Baltimore,  assuming  the  above  esti- 
mate to  be  correct,  a  weekly  population  of  7829.  For  the  week 
ending  November  1.  1884,  the  deaths  in  that  city  numbered  148. 
The  annual  death-rate  per  1000 — that  is  to  say,  the  number  of 
deaths  in  each  1000  of  population,  if  the  same  ratio  were  main- 
tained throughout  the  year — is  obtained  as  follows : — 

U8X1000 

„„„» =  18.9  per  M  per  annum. 

Out  of  the  above  148  deaths,  32  were  from  infectious  dis- 
eases. To  find  the  annual  death-rate  per  1000  of  population  for 
this  class  of  diseases,  the  same  calculation  is  made,  thus : — 

32  X  1000 

^tttt, —  =  4.1  per  AL  per  annum. 

(829  L 

Or.  if  the  percentage  of  deaths  of  infectious  diseases  be 
desired,  the  procedure  would  be  as  follows  : — 

32  X  100 

^73 =  21.6  per  cent,  of  the  total  deaths. 

14o 

Sixty-four  of  the  decedents  were  under   5   years  of  age. 

The  death-rate  for  this  class  is  found  in  the  same  manner ;  for 

example : — 

64X1000      0,„ 

— 7090 —  =  8.1 1  per  M  per  annum. 

Or  the  percentage  of  these  to  the  total  deaths  is  found  as  in  the 
last  example. 


VITAL    STATISTICS.  363 

If  it  be  desired  to  find  the  rate  of  infant  mortality,  i.e.,  the 
proportion  of  deaths  among  infants  under  1  year  of  age  to  the 
total  number  of  births  for  the  same  period,  the  following  formula 
may  be  used.  In  the  record  just  quoted  the  decedents  under 
1  year  of  age  numbered  37 ;  the  total  number  of  births  for  the 
same  week  was  157.     Hence — 

QW  1  Ann 

^57        =  235.7  per  1000  births, 

or  nearly  1  to  4. 

Thirty-three  of  these  148  deaths  were  of  colored  persons. 
The  death-rate  of  these  to  the  total  population  is  found  in  a 
similar  manner  to  the  above ;  but  if  it  is  desired  to  ascertain  the 
death-rate  of  the  colored  population  alone,  the  weekly  colored 
population  must  first  be  obtained  and  the  rate  calculated  from 
this  by  the  above  formula. 

Birth-rates  are  found  in  a  similar  manner.  The  average 
age  at  death  is  ascertained  by  adding  up  the  ages  of  all  the 
decedents,  and  dividing  the  sum  by  the  number  of  deaths. 

It  will  be  evident,  on  a  little  thought,  that  there  must  be 
many  sources  of  error  in  calculations  based  upon  such  uncertain 
data  as  are  derived  from  the  registration  of  births  and  deaths  as 
conducted  in  most  cities  in  this  country.  Besides,  the  subject  of 
vital  statistics  is  essentially  abstruse,  and  requires  no  little  readi- 
ness in  mathematics  to  appreciate  its  profounder  bearings. 
Hence,  in  the  foregoing  chapter  no  attempt  has  been  made  to 
penetrate  beyond  the  immediate  practical  aspects  of  the  ques- 
tions involved. 

[To  those  desiring  fuller  information  upon  this  subject,  the 
following  works  are  recommended : — 

Curtis,  Vital  Statistics,  in  Buck's  Hygiene  and  Public  Health. — 
Billings,  Registration  of  Vital  Statistics,  American  Journal  Medical  Sci- 
ences, vol.  lxxxv. — Oldendorff,  Morbilitaets  and  Mortalitsets-Statistik,  in 
Realenc}^clopa3die  d.  ges.  Heilk.,  Bd.  IX. — Billings,  Papers  on  Vital  Sta- 
tistics, Sanitary  Engineer,  vol.  viii,  ix. — Ibid.,  Cartwright  Lectures  on 
Vital  and  Medical  Statistics,  1890.] 


CHAPTER  XXII. 

Quarantine. 

(By  Walter  Wyman'M.D,,  Surgeon  United  States  Marine-Hospital  Service.) 

By  quarantine  is  meant  the  adoption  of  restrictive  measures 
to  prevent  the  introduction  of  diseases  from  one  country  or 
locality  into  another.  The  term  itself  conveys  no  definite  idea, 
being  derived  through  the  Italian  from  the  latin  "quadraginta," 
meaning  "  forty  "  and  implying  forty  days,  the  period  of  deten- 
tion imposed  on  vessels  by  the  first  quarantines  established  at 
Venice  in  1403.  The  old  significance  of  the  term  is  entirely 
lost  in  its  present  application,  which  is  quite  general.  Thus, 
besides  regular  maritime  quarantine,  mention  is  often  made  of 
land,  railroad,  cattle,  shot-gun,  house,  and  even  room  quaran- 
tines. 

The  name  of  a  disease  or  article  of  merchandise  may  be 
ased  in  prefix,  as  in  "yellow-fever  quarantine,"  small-pox, 
cholera,  or  rag  quarantine.  Moreover,  quarantines  are  described 
as  properly  beginning  at  the  port  of  departure,  and  as  quaran- 
tines of  inspection  only,  the  fumigation  and  detention  being 
imposed  at  some  neighboring  station.  The  term,  therefore,  is 
applied  not  only  to  establishments,  but  indifferently  to  persons, 
animals,  diseases,  localities,  and  measures. 

There  is  need  of  a  clear  understanding  with  regard  to  the 
term,  for  when,  as  occasionally,  quarantine  is  ridiculed,  or  the 
assertion  is  made  that  the  English  disbelieve  in  quarantine,  a 
wrong  impression  will  be  received,  unless  it  is  understood  that 
only  particular  and  obsolete  forms  of  quarantine  are  meant, 
and  not  quarantine  in  the  broad  sense  just  mentioned. 

The  subject  admits  of  two  natural  divisions — maritime  and 
land  quarantine ;  but  before  describing  them  attention  is  called 
to  the  following  table,  containing  a  list  of  diseases  that  are  ordi- 
narily found  in  official  quarantine  proclamations  : — 

(365) 


366  TEXT-BOOK   OF   HYGIENE. 

QUARANTINABLE   DISEASES. — TABLE   XXIX. 


Period  of  Incubation,  in  Days. 

Shortest. 

Longest. 

Usual. 

Authority  and  Remarks. 

Plaoue    . 

1 

2 
1 
5 

7 
2 
7 
1 
5 
1 

*9 
14 
21 
20 
14 
10 
28 
weeks. 
7 
10 

2  to    4 
5  to  14 

10 

10 
2  to  5 

21 
4  to  7 

6 

5 

Bristow.    Undetermined. 

Yellow  fever  . 

Da  Costa,  Bartholow. 

Typhus  fever  . 
Small-pox  .     . 
Measles  . 

Bristow. 
Da  Costa. 
Da  Costa. 

Diphtheria .     . 
Typhoid  fever 
Scarlet  fever   . 
Relapsing  fever 

Leprosy. 

Bartholow. 
Bartholow. 
Da  Costa. 
Bartholow. 
Bartholow. 
Und  eter  mined. 

The  above  list  illustrates  the  growth  of  the  sanitary  idea 
and  belief  in  quarantine.  For  many  years,  as  now  at  some 
ports,  the  list  was  limited  to  yellow  fever,  typhus,  cholera,  and 
small-pox.  It  was  thus  limited  at  Boston  prior  to  1881,  since 
which  date  diphtheria,  scarlet  fever,  typhoid  fever,  and  measles 
have  been  added.  The  statutes  of  New  York  define  as  quaran- 
tinable  "yellow  fever,  measles,  cholera,  typhus  or  ship  fever, 
small-pox,  scarlatina,  diphtheria,  relapsing  fever,  and  any  dis- 
ease of  a  contagious,  infectious,  or  pestilential  character,  which 
shall  be  considered  by  the  health  officer  dangerous  to  the  public 
health." 

At  Gibraltar,  the  English  sanitary  authorities  include 
dengue  and  epidemic  rose-rash  among  the  diseases  subject  to 
their  quarantine  regulations. 

The  most  recent  addition  to  the  list  in  this  country  is 
leprosy,  to  prevent  the  introduction  of  which,  and  in  accord- 
ance with  a  resolution  of  the  American  Public  Health  Associa- 
tion, a  prohibitory  circular  was  issued  by  the  Surgeon-General 
of  the  Marine-Hospital  Service,  December  23,  1889. 

Other  diseases  which  may  properly  call  for  quarantine  are 
mumps,    whooping-cough,    chicken-pox,    epidemic    dysentery, 


MARITIME    QUARANTINE.  367 

glanders,  tetanus,  beriberi,  epidemic  influenza,  and  pulmonary 
tuberculosis. 

Influenza  may  be  considered  quarantinable  under  certain 
circumstances,  a  successful  quarantine  being  reported  by  Dr. 
Trudeau,  whose  cottage  sanitarium,  in  the  Adirondacks,  New 
York,  was  thus  kept  exempt  during  the  epidemic  of  1890. 

With  regard  to  pulmonary  tuberculosis  the  ground  is  taken 
by  the  writer  that  this  disease,  at  least  among  immigrants,  should 
be  excluded  from  the  United  States  by  quarantine. 

MARITIME    QUARANTINE. 

In  describing  a  maritime  quarantine  it  should  be  borne  in 
mind  that  the  details  in  the  plant  must  vary  in  accordance  with 
the  special  demands  of  each  port. 

Thus,  it  is  not  to  be  expected  that  at  Charleston,  where 
immigration  is  limited,  there  should  be  the  same  provisions  for 
detention  of  immigrants  as  at  New  York,  through  whose 
portals  more  than  one-third  of  a  million  of  immigrants  pass 
feach  year  ;  or  San  Francisco,  where  enter  the  throng  of  travelers 
and  immigrants  from  the  far  East. 

We  should  not  expect  that  Boston,  in  the  more  salubrious 
North,  would  have  the  means  or  adopt  the  practice  of  emptying, 
cleaning,  and  fumigating  every  vessel  from  an  infected  port, 
which  process  has  proven  to  be  the  sine  qua  non  of  exemption 
to  the  State  of  Louisiana. 

Nor  should  we  expect  Pensacola,  with  a  completely- 
equipped  national  refuge-station  near  at  hand  (at  Chandeleur 
Island),  to  erect  an  expensive  disinfecting-house,  with  modern 
steam  disinfecting-chambers,  as  has  been  recently  done  for  the 
port  of  Galveston  by  the  health  authorities  of  Texas. 

But,  leaving  these  variations  for  subsequent  notice,  the 
first  thing  to  be  considered  in  the  establishment  of  a  complete 
maritime  quarantine  is  proper  location.  This  must  be  at  a 
point  remote  from  city  or  village  boundaries,  and  not  likely  to 
be  encroached  upon  by  urban  growth.     It  should  be  more  or 


368  TEXT-BOOK    OF    HYGIENE. 

less  removed  from  the  channels  of  commerce,  and  yet  be  easily 
accessible.  Indifference  to  proper  location  could  readily  make 
the  quarantine  a  source  of  danger  instead  of  a  protection.  After 
proper  location,  the  main  requirements  may  be  stated  as 
follows : — 

1.  A  boarding-station.  This  includes  a  boat-house  with 
boatmen's  quarters,  so  located  as  to  avoid  possible  infection  from 
the  lazaretto  and  to  be  within  easy  reach  of  passing  commerce. 

2.  A  boarding-boat,  preferably  a  steamer. 

3.  An  anchorage.  The  anchorage  is  the  place  of  detention 
of  the  infected  vessel.  It  should  be  conveniently  removed  from 
the  main  establishment  and  safely  remote  from  the  track  of 
commerce.  Its  position  should  be  sheltered,  and  good  holding- 
ground  for  vessels'  anchors  is  of  the  first  importance.  The 
channel  to  the  anchorage,  and,  if  necessary,  its  boundaries, 
should  be  plainly  marked  by  buoys. 

4.  A  fumigation  steamer,  to  be  described  under  "  Quaran- 
tine Contrivances." 

5.  A  wharf.  The  wharf  should  be  in  water  of  at  least  20 
feet  depth,  and  there  should  be  constructed  upon  it  a  ware- 
house, tanks  for  holding  disinfecting-solutions,  and  a  disinfection- 
house  containing  steam  disinfecting-chambers. 

6.  A  lazaretto  or  hospital  for  treatment  of  contagious 
diseases. 

7.  A  hospital  for  treatment  of  non-contagious  diseases. 

8.  Barracks  for  the  detention  in  groups  of  "  suspects,"  or 
persons  who  have  been  exposed  to  contagion  or  infection. 

9.  Quarters  for  medical  officers. 
10.  A  cremation-furnace. 

No  better  understanding  of  the  subject  can  be  had  than  by 
a  brief  survey  of  the  several  varieties  of  maritime  quarantines 
that  are  now  maintained  on  the  coasts  of  the  United  States. 
First  should  be  mentioned  the  national  quarantine  stations,  eight 
in  number,  established  at  points  of  danger  where  either  local 
quarantine  is  defective,  or  where,  by  reason  of  peculiar  advan- 


MARITIME    QUARANTINE.  369 

tage  in  location,  protection  is  afforded  to  several  States  by  one 
Station.     These  stations  are  as  follow: — 

Delaware  Breakwater  Quarantine  Station,  Lewes,  Del.; 
Cape  Charles  Quarantine  Station,  Fisherman's  Island,  Va. ; 
South  Atlantic  Quarantine  Station,  Blackbeard  Island,  Sapelo 
Sound,  Georgia;  Key  West  Quarantine  Station,  Tortugas 
Islands,  Fla. ;  Gulf  Quarantine  Station,  Chandeleur  Island, 
Miss.;  San  Diego  Quarantine  Station,  San  Diego,  California; 
San  Francisco  Quarantine  Station,  Angel  Island,  San  Francisco 
Bay,  California;  and  Port  Townsend  Quarantine  Station,  Port" 
Townsend,  Washington. 

Most  of  these  stations  will  be  complete  in  plant  and  equip- 
ment within  a  short  time,  but  pending  completion  active  quaran- 
tine is  maintained  the  whole  year  through  at  all  of  them,  San 
Francisco  excepted, — there  being  a  local  quarantine  at  this  port. 

The  estimated  cost  of  the  national  quarantine  station  at 
Angel  Island,  San  Francisco  Bay,  is  $175,000,  exclusive  of  the 
site,  which  was  in  previous  possession  of  the  government. 

Surgeon-General  Hamilton,  in  a  recent  report,  says: — 

"  It  is  evident  that  a  few  complete  stations  of  this  kind 
will  take  the  place  of  the  many  municipal  quarantines.  The 
latter '  will  become,  eventually,  simply  boarding-stations,  and 
vessels  requiring  treatment  will  be  sent  to  the  nearest  govern- 
ment quarantine  station." 

No  fees  are  exacted  at  the  national  stations. 

Many  of  the  local  quarantine  establishments,  while  entirely 
effective  for  ordinary  quarantine,  the  occasional  detection  and  care 
of  a  few  contagious  cases,  would  prove  insufficient  and  become, 
in  fact,  more  dangerous  than  beneficial  in  the  presence  of  a  heavy 
inroad  of  an  epidemic  disease,  such  as  the  appearance  of  a  ship- 
with  a  thousand  emigrants  aboard,  having  a  history  of  many 
deaths  at  sea  from  cholera,  and  cholera  still  prevailing  among 
them.  Deficiencies  in  the  plant  and  the  want  of  modern  appli- 
ances and  proper  accommodations  would  create  embarrassment, 
while  the  location,  once  remote  from  populous  centres,  but  now 

21 


370  TEXT-BOOK   OF   HYGIENE. 

no  longer  isolated,  would  at  once  be  recognized  as  hazarding  the 
safety  of  the  neighboring  population. 

It  is  in  recognition  of  these  facts  that  the  health  authorities 
of  the  various  States  and  cities  interested  have  contributed  their 
influence  to  the  establishment  of  the  national  quarantines,  using 
them  as  refuge-stations. 

Among  the  State  and  local  quarantines,  variety  of  type  is 
presented  by  those  of  Boston,  New  York,  Louisiana,  Galveston, 
Philadelphia,  Baltimore,  and  Charleston.  The  first  four  of 
these  are  complete  in  themselves,  and  independent  of  extraneous 
aid.  The  others  make  use  of  the  national  stations,  particularly 
for  the  anchorage  and  cleansing  of  foul  ships.  The  city  of 
Charleston,  for  example,  has  a  complete  plant  of  approved 
modern  design  for  the  disinfection  by  steam  of  clothing,  baggage, 
and  bedding,  but  use  is  made  of  the  neighboring  national  station 
at  Blackbeard  Island  for  the  treatment  of  the  infected  vessel. 

To  complete  this  description  of  maritime  quarantines  it 
only  remains  to  mention  the  special  characteristics  of  the  State 
quarantine  establishments  of  New  York  and  Louisiana. 

THE    NEW   YORK   QUARANTINE. 

This  consists  of — 

1.  A  ship,  or  hull,  anchored  in  the  lower  bay, — the  bay 
farthest  from '  the  city.  The  hull  is  anchored  about  4  miles 
inside  of  Sandy  Hook,  and  about  11  miles  from  New  York. 
This  is  the  boarding-station  from  May  until  November,  vessels 
being  visited  by  means  of  a  row-boat. 

2.  Swinburne  Island, — called  also  Dix  Island, — located 
two  or  three  miles  from  the  boarding-station,  nearer  to  New 
York,  with  an  area  of  two  or  three  acres,  on  which  are  erected 
the  hospitals  for  the  treatment  of  the  sick,  and  also  a  cremation- 
furnace. 

3.  Hoffman  Island, — like  the  former,  an  artificial  island, — 
still  nearer  to  New  York  by  about  one  mile,  on  which  are  build- 
ings for  the  accommodation  of  two  thousand  immigrants,  with 


THE    LOUISIANA   QUARANTINE.  371 

interior  arrangements  for  their  division  into  groups,  while  await- 
ing the  development  of  any  contagious  or  infections  disease 
among  them.  A  steam  disinfecting-apparatus  for  the  dry  or 
moist  heat  disinfection  of  baggage,  clothing,  etc.,  has  been 
established  upon  this  island. 

4.  Residence  of  the  health  officer,  on  the  "Narrows,"  near 
Clifton,  Staten  Island,  6  miles  from  New  York. 

5.  The  Anchorage,  where  infected  vessels  are  treated.  This 
is  also  in  the  lower  bay,  which  is  of  so  great  area  that  a  safe 
location  of  the  vessel  is  easily  effected. 

THE    LOUISIANA   QUARANTINE. 

To  the  Louisiana  State  Board  of  Health  and  its  successive 
presidents,  Drs.  C.  B.  White,  Samuel  Choppin,  Joseph  Jones, 
Joseph  Holt,  and  C.  P.  Wilkinson,  is  due  the  credit  both  of 
combating  the  pernicious  theory  of  non-quarantine  and  of  per- 
fecting a  system  of  quarantine  that  is  recognized  as  the  most 
extensive  and  efficient  ever  devised,  and  from  which  a  number 
of  others  have  been  modeled.  Though  utilizing  the  devices  of 
others,  notably  that  of  Quarantine  Officer  Dr.  Perry,  for  gener- 
ating and  forcing  into  vessels'  holds  sulphur  dioxide,  and 
though  his  plant  has  been  improved  by  his  successor,  neverthe- 
less the  credit  of  this  new  and  thorough  system  is  justly  given 
to  Dr.  Joseph  Holt,  President  of  the  Board  of  Health  from  1884 
to  1888,  to  whose  determined  energy  and  genius  sanitary  and 
commercial  interests  are  equally  indebted. 

The  improved  quarantine  consists  of,  first — 

The  Mississippi  River  Quarantine  Station.  This  is  located 
about  90  miles  below  New  Orleans  and  4  miles  above  the  "  Head 
of  the  Passes,"  or  point  where  the  river  divides  into  its  three 
main  outlets. 

The  plant  consists  of  five  buildings  exclusive  of  out-houses, 
viz.,  a  disinfecting- shed  and  boiler-room,  quarters  and  mess-hall 
for  the  disinfecting-crew,  boat-house  and  boatmen's  quarters,  and 
two  residences  for  the  quarantine  officer  and  his  assistant. 


372  TEXT-BOOK    OF    HYGIENE. 

The  disinfecting-shed  immediately  adjoins  a  wharf  built  in 
water  of  sufficient  depth  to  allow  the  largest  vessels  to  be 
moored  alongside. 

The  following  description  is  from  the  report  of  Dr.  C.  P. 
Wilkinson,  President  of  the  Louisiana  State  Board  of  Health  : — 

The  disinfecting  apparatus  consists  of  three  cylindrical  steel  cham- 
bers and  appurtenances,  each  cylinder  being  50  feet  long  and  8  feet  in 
diameter.  The  ends  are  spherical,  and  that  facing  the  river  or  front  end 
is  movable,  swinging  open  by  means  of  a  crane.  At  a  point  50  feet  in 
front  of  each  cylinder  commences  a  double,  iron,  elevated  track,  which,  by 
a  movable  section,  continues  into  and  throughout  the  length  of  each 
cylinder. 

On  this  track  rolls  a  truck  48  feet  in  length,  and  from  this  truck 
are  suspended  thirty  clothes-racks  of  5  bars  each.  The  interior  of  each 
cylinder  contains  an  arrangement  for  the  employment  of  moist  and  dry 
heat,  separately  and  together.  The  necessary  heat  is  supplied  by  a 
40-horse-power  steam-boiler  at  85  to  100  pounds'  pressure. 

Surmounting  the  shed  is  a  cypress  cistern,  the  bottom  of  which  is 
41  feet  above  the  river-surface,  capable  of  holding  7000  gallons  of  fluid. 
In  this  cistern  is  stored  a  solution  of  mercuric  chloride,  1  part  to  1000 
of  water  by  weight.  Pipes  lead  from  this  cistern  to  the  outer  edge  of 
the  wharf,  and  at  that  point  have  rubber-hose  attachments  of  sufficient 
length  to  lead  to  all  parts  of  a  very  large  vessel,  and  the  hoses  terminate 
in  hard-rubber  roses  of  6-inch  face. 

The  fumigating  apparatus,  heretofore  on  a  tug,  but  now  proposed 
to  be  erected  on  rail-cars  on  the  wharf,  consists  of  a  reverberatory  sul- 
phur-furnace, with  250  feet  of  galvanized-iron  conductors,  12  inches  in 
diameter,  and  a  steam  fan.  The  furnace,  24  inches  wide,  48  high,  and  40 
deep,  is  provided  with  four  cast-iron  pans,  30  inches  long,  23  wide,  and  4 
deep,  each  pan  having  over  1^  cubic  feet  capacity,  or  about  175  pounds 
of  sulphur.  The  pans  are  set  on  split  brick,  and  are  so  placed  that  the 
current  of  air  driven  by  the  fan  into  the  bottom  passes  over  each  pan  of 
burning  sulphur  alternately,  out  through  the  top  and  along  the  conduc- 
tors down  into  the  holds  of  vessels. 

The  process  of  disinfection  of  vessels  consists  in  placing  all  baggage, 
bedding,  curtains,  carpets,  linen,  etc., — in  fact,  all  textile  fabrics  of  vessel, 
crew,  and  passengers, — on  the  suspended  clothes-racks,  which  are  then 
drawn  into  the  cylinders  by  a  windlass,  and  applying  dry  heat  until  the 
thermometers  mark  185°  F.  (85°  C),  at  which  point  moist  heat  is  turned 
on,  the  temperature  rapidly  rises  to  215°  to  220°  F.  (102°  to  105°  C.),and 


THE    LOUISIANA    QUARANTINE.  373 

the  gauges  usually  record  a  pressure  of  7  pounds  to  the  square  inch,  at 
which  point  the  blow-off  valves  open,  preventing  anjr  danger  of  explosion. 
The  contents  of  the  chambers  are  kept  at  this  temperature  and  pressure 
for  thirty  minutes,  the  cylinders  are  then  opened,  and  the  goods  turned 
over  to  their  owners.  The  vessel  in  the  meantime  is  washed  down — cabins, 
forecastles,  decks,  and  holds — with  the  mercuric-chloride  solution,  and 
fumigated  by  means  of  the  furnace  and  fan.  In  the  case  of  loaded  vessels, 
washing  the  interior  is  omitted,  on  account  of  danger  to  cargo.  The  holds 
are,  however,  thoroughly  fumigated,  and,  by  a  special  arrangement  of 
"  cargo  wells,"  the  gas  penetrates  every  interspace  of  cargo.  These  wells 
are  constructed  at  port  of  departure,  and  consist  of  a  long  wooden  box- 
about  two  feet  across, and  reach  from  the  bottom  to  top  of  holds,  the  cargo 
being  stowed  around  them  at  loading-point.  The  conductor  from  the 
sulphur-furnace  is  led  into  the  well,  the  hatches  are  tightly  closed,  and, 
under  pressure,  the  fumes  of  sulphur  are  driven  into  the  vessel,  the  gas 
passing  around  every  package  envelope,  no  matter  how  tightly  packed, 
and  chemical  examination  showed  that  in  the  case  of  sugar-bags  it  pene- 
trated to  the  depth  of  three-fourths  of  an  inch.  The  character  of 
cargoes  arriving  here  from  infected  ports  is  almost  exclusively  coffee  and 
sugar,  the  former  always,  and  the  latter  nearly  always,  in  bags,  neither 
offering  obstacles  to  good  and  sufficient  fumigation  in  situ. 

When  necessary,  the  cargo  is  shifted  to  lighters  for  more  thorough 
disinfection. 

Passengers  are  required  to  don  their  disinfected  wearing-apparel  to 
permit  disinfection  of  that  the}r  may  be  wearing  on  arrival. 

Most  all  of  the  quarantine  work  is  accomplished  at  this 
Mississippi  River  Station. 

The  second  or  Lower  Quarantine  Station  is  situated  in 
Pass  a  L'Outre,  an  unused^  outlet  of  the  Mississippi,  a  few  miles 
below  the  Head  of  the  Passes.  At  this  station  is  the  lazaretto, 
or  hospital  for  infectious  diseases,  and  it  is  the  anchorage  also  for 
infected  vessels. 

Other  stations  are  the  Advance  Guard  Inspection  Station 
at  Port  Eads,  110  miles  below  New  Orleans,  where  the  waters 
of  South  Pass  are  jettied  into  the  Gulf,  and  the  Rigolets  and 
Atchafalaya  Stations.  The  two  latter  control  the  two  lateral 
approaches  to  New  Orleans,  and,  as  the  shipping  coming  through 
these  two  channels  is  light  in  tonnage  and  mostly  from  domestic 


374:  TEXT-BOOK   OF   HYGIENE. 

ports,  by  imposing  a  quarantine  of  forty  days'  detention  the  two 
approaches  are  practically  closed,  compelling  all  vessels  to  seek 
the  Mississippi  as  the  only  available  route  to  New  Orleans. 

The  following  description  is  for  the  most  part  verbatim, 
from  the  pen  of  Dr.  Joseph  Holt  (see  "  Transactions  of  the 
American  Public  Health  Association,"  1887,  vol.  xiii) : — 

When  an  inward-bound  vessel  comes  into  the  offing,  she  is  imme- 
diately hoarded  by  a  thoroughly  skilled  medical  officer,  and  a  careful  in- 
spection is  made  of  her  sanitary  record  and  present  condition.  If  from 
a  non-quarantined  port,  and  all  is  well,  she  is  given  pratique  and  goes  on 
to  the  city.  If  from  a  quarantined  port,  but  presenting  a  clean  health- 
record  of  voyage  and  no  evidence  of  sickness  of  a  dangerous  or  doubtful 
character,  she  proceeds  to  the  Mississippi  River  Quarantine  Station, 
where  she  is  subjected  to  a  full  course  of  sanitary  treatment,  and  is  de- 
tained such  length  of  time,  not  exceeding  five  days  (except  in  rare  in- 
stances wherein  further  observation  ma}'  be  deemed  necessary),  as  the 
Board  of  Health  may  provide. 

If,  upon  inspection  of  a  vessel  entering  the  river  she  is  found  to  be 
foul, — that  is,  showing  positive  or  suspicious  evidence  of  infection  either 
in  a  person  then  ill  or  in  a  foul  health-record  of  voyage, — she  is  at  once 
remanded  to  the  lower  station  in  Pass  a  L 'Outre.  The  sick,  if  any,  are  at 
once  removed  to  the  hospital,  where  every  provision  has  been  made.  The 
vessel  with  the  well  on  board  is  dropped  down-stream  a  few  hundred 
yards  and  anchored.  The  quarantine  tug-boat,  with  its  complete  dis- 
infecting outfit,  comes  alongside,  and  the  work  of  disinfection  begins, 
and  does  not  cease  until  the  vessel  has  been  subjected  to  the  most  vigor- 
ous application  of  the  solution  of  bichloride  of  mercury,  her  atmosphere 
below  deck  completely  replaced  with  one  heavily  charged  with  sulphurous 
oxide,  and  every  article  of  baggage  and  ship's  wardrobe  has  been  satu- 
rated with  the  mercuric  solution. 

A  ship  known  to  be  infected  with  one  of  the  three  great  pestilential 
diseases — small-pox,  cholera,  or  yellow  fever — can  stand  and  must  endure 
extraordinaiy  treatment,  even  if  clothing  is  wetted  and  some  articles 
damaged. 

The  immediate  segregation  of  the  sick  and  the  well  and  disinfection 
of  the  ship  and  all  baggage  (in  the  case  of  a  cholera-infected  vessel, 
extended  to  the  disinfectant  washing  out  and  refilling  of  the  water-tanks, 
destruction  of  the  food-suppty,  and  revictualing  the  vessel)  constitute 
the  treatment  of  an  infected  vessel  at  this  station.  The  ship,  together 
with  all  on  board,  is  held  for  observation  a  period  of  ten  days  or  more, 


THE    LOUISIANA   QUARANTINE.  375 

according  to  circumstances,  when  she  is  released  and  proceeds  to  the 
Mississippi  River  Station,  where  the  processes  of  sanitary  treatment  are 
repeated,  with  the  addition  of  the  use  of  moist  heat  applied  to  baggage, 
ship's  apparel,  etc. ;  and  the  vessel  is  then  allowed  to  proceed  to  the 
city. 

The  tug-boat  mentioned  is  of  sufficient  power  to  move  a  vessel  to 
or  from  the  wharf,  and  is  equipped  with  a  complete  outfit  for  generating 
and  applying  germicidal  gas  for  the  displacement  of  the  entire  atmos- 
phere within  the  ship,  transported,  perhaps,  directly  from  some  infected 
port.  In  the  hold  of  this  tug  is  constructed  a  wooden  tank  of  2000 
gallons  capacity,  to  hold  the  bichloride-of-mercury  solution,  for  treatment 
of  vessels  in  the  lower  quarantine.  This  tank  is  furnished  with  a  steam- 
pump  made  of  iron  (on  account  of  the  greater  resistance  of  that  metal 
to  amalgamation),  supplied  with  a  f-inch  rubber  hose. 

The  quarantine  procedure  at  the  Louisiana  quarantine 
stations  may  be  further  understood  through  the  following  quar- 
antine  proclamation    by    the    Governor  of  the  State,  May  1, 

1890:— 

Executive  Department,  State  of  Louisiana. 

In  conformity  with  the  provisions  of  Section  3049  of  the  Revised 
Statutes  of  the  State,  and  upon  the  advice  of  the  State  Board  of  Health, 
requesting  the  Governor  to  issue  his  annual' proclamation  of  quarantine 
against  the  hereinafter  enumerated  and  mentioned  ports,  to  take  effect 
from  and  after  the  1st  day  of  Majr,  A.D.  1890,  to  wit : — 

All  vessels  arriving  at  the  several  quarantine  stations  in  this  State, 
together  with  their  crews,  cargoes,  and  passengers,  shall  be  subjected  to 
inspection  by  the  quarantine  officers  at  said  stations. 

All  vessels,  together  with  their  cargoes,  crews,  passengers,  and 
baggage  arriving  at  the  Mississippi  River  Quarantine  Station  from  inter- 
tropical American  and  West  Indian  ports  shall  be  subjected  to  thorough 
maritime  sanitation  according  to  the  following  schedule,  to  wit: — 

First  Class. — Vessels  arriving  from  non-infected  ports. 

Second  Glass. — Vessels  arriving  from  suspected  ports. 

Third  Class. — Vessels  arriving  from  ports  known  to  be  infected. 

Fourth  Class. — Vessels  which,  without  regard  to  port  of  departure, 
are  infected ;  that  is  to  say,  vessels  which  have  yellow  fever,  cholera,  or 
other  contagious  or  infectious  disease  on  board  at  time  of  arrival,  or 
have  had  same  on  voj^age. 

Vessels  of  the  first  class  to  be  subjected  to  necessary  maritime 
sanitation  at  the  Mississippi  River  Quarantine  Station,  without  detention 


376  TEXT-BOOK   OF   HYGIENE. 

of  either  vessel  or  persons  longer  than  may  be  necessary  to  place  such 
vessel  in  perfect  sanitary  condition. 

Vessels  engaged  in  the  tropical-fruit  trade  and  coming  from  known 
non-infected  localities,  and  whose  sanitary  condition  and  health-record 
are  satisfactory,  may  be  allowed  to  pass  the  quarantine  station  after 
inspection,  subject,  however,  to  such  regulations  and  sanitary  treatment 
as  the  Board  of  Health  may  prescribe. 

Vessels  of  the  second  and  third  classes  to  undergo  the  same  con- 
ditions as  those  of  the  first  class,  together  with  detention  for  observation 
for  a  period  of  five  full  days  from  hour  of  arrival  in  quarantine. 

Vessels  of  the  fourth  class  to  be  remanded  to  the  Lower  Quarantine 
Station,  there  to  undergo  sanitation  and  detention  of  vessel  and  persons 
such  length  of  time  as  the  Board  of  Health  may  determine. 

All  vessels  arriving  from  ports  known  or  suspected  to  be  infected 
with  cholera  or  small-pox,  or  which  may  hereafter  become  infected,  shall 
be  subjected  to  maritime  sanitation  and  such  detention  as  the  Board  of 
Health  ma}T  determine. 

Vessels  arriving  from  the  above-named  ports  and  places,  and  be- 
longing to  the  second,  third,  and  fourth  classes,  as  is  set  forth  in  the 
above  schedule,  shall  not  be  allowed  to  pass  the  Rigolets,  the  Atchafalaya, 
or  Lake  Charles  Quarantine  Stations,  or  other  State  quarantine  stations 
which  may  hereafter  be  established,  without  having  undergone  a  period 
of  detention  of  forty  da}Ts  and  thorough  cleaning  and  disinfection. 

Now,  therefore,  I,  Francis  T.  Nicholls,  Governor  of  the  State  of 
Louisiana,  have  thought  proper  to  issue  this,  my  annual  proclamation 
of  quarantine,  directing  that  quarantine  shall  take  effect  from  and  after 
Thursda}',  the  1st  day  of  May,  A.D.  1890,  against  the  above-mentioned 
ports,  and  as  contained  in  the  foregoing  schedule. 

Quarantine  officers  at  the  several  stations  in  this  State  are  especially 
charged  and  required  to  strictly  enforce  the  execution  of  this  proclama- 
tion, and  the  Board  of  Health  in  the  city  of  New  Orleans  is  requested  to 
prosecute  vigorousl}'-  all  violations  of  the  same,  as  well  as  the  quarantine 
laws  and  regulations  of  this  State. 

In  testimonj'  whereof  I  have  hereunto  affixed  my  signature,  authen- 
ticated with  the  seal  of  the  State  of  Louisiana,  at  the  city  of  Baton 
llouge,  this  eighteenth  day  of  April,  in  the  year  of  our  Lord  one  thou- 
sand eight  hundred  and  ninety. 

Francis  T.  Nicholls, 

Governor  of  Louisiana. 
3y  the  Governor : 

Geo.  Spencer, 

Assistant  Secretary  of  Stale. 


QUAKANTINE    CONTRIVANCES.  377 

Sjiecial  Suggestions  to  Owners,  Agents,  Masters  of  Vessels,  and  Passengers. 

The  Louisiana  State  Board  of  Health  recommends  the  following 
suggestions  to  agents,  owners,  masters  of  vessels,  and  passengers  for 
the  purpose  of  facilitating  the  work  of  quarantine  officers  and  reducing 
the  period  of  detention  to  a  minimum  : — 

1.  That  vessels  should  be  stripped  during  the  quarantine  season 
of  all  woolen  hangings,  carpets,  curtains,  and  such-like  materials,  and 
upholstered  furniture  as  far  as  practicable.  Hair  or  moss  mattresses  to 
be  replaced  Ivy  wire  or  wicker  beds. 

2.  That  as  far  as  possible  vessels  trading  with  tropical  ports  should 
be  manned  with  acclimated  crews. 

3.  Masters  of  vessels  and  ship  and  consular  agents  are  earnestly 
requested  to  instruct  passengers  from  quarantinable  ports  to  dispense,  as 
far  as  possible,  with  baggage  which  may  be  injured  by  wetting,  in  case 
of  pestilential  outbreak  on  board,  while  undergoing  disinfection.  Such 
passengers  are  especially  warned  against  bringing  silks,  laces,  velvets, 
and  other  fabrics  of  delicate  texture,  as  they  will  be  compelled  to  assume 
all  risks  of  injury. 

4.  While  in  ports  infected  with  j^ellow  fever,  vessels  should  be 
anchored  out  in  the  harbor,  when  this  is  possible,  and  the  crew  prohibited 
from  going  ashore,  especial^  at  night. 

5.  When  practicable,  cargoes  should  be  loaded  in  such  a  manner  as 
to  allow  access  to  the  pumps,  and  also  to  enable  the  quarantine  officials 
to  pump  out  and  wash  the  bilge. 

6.  Special  attention  should  be  given  to  cleanliness  of  vessels  and 
persons,  and  provision  should  be  made  for  all  possible  ventilation  of 
the  entire  vessel.  The  best  disinfectants  and  instructions  for  using  the 
same  can  be  obtained  \>y  application  to  the  Board  of  Health  or  any  of 
its  officers. 

7.  Masters  should,  before  arrival,  see  that  the  bilge  is  thoroughlv 
pumped  out  and  cleansed,  and  that  the  entire  vessel  be  put  in  such  good 
sanitary  condition  as  to  permit  of  the  least  possible  detention.  Fruit 
vessels,  particularly,  should  be  kept  thoroughby  cleansed  for  the  purpose 
of  avoiding  delay  at  the  quarantine  station. 

8.  Vessels  observing  the  aboA'e  recommendations  will  receive  special 
consideration  at  the  quarantine  station,  detention  and  cost  of  cleaning, 
disinfecting,  etc.,  being  materially  lessened  thereby. 

QUARANTINE    CONTRIVANCES. 

Of  modern  contrivances  first  should  be  mentioned  the 
disinfection    steamer.     This  must  be  a  powerful  boat  on  the 


378  TEXT-BOOK    OF   HYGIENE. 

general  plan  of  a  tug-boat,  about  85  feet  in  length  on  the 
water-line,  provided  with  iron  tanks  of  at  least  2000  gallons' 
capacity  for  holding  the  solution  of  bichloride  of  mercury,  to 
which  may  be  attached  a  steam-pump  and  rubber-outlet  hose. 
To  prevent  contact  of  the  mercury  with  the  iron  the  tanks  may 
be  painted  with  three  coats  of  red  lead  and  two  of  parafnne  paint 
(Holt). 

The  steamer  is  also  provided  with  a  steam-fan,  by  means  of 
which  fresh  air  may  be  made  to  displace  foul  air  in  the  hold  of 
the  vessel  under  treatment.  A  sulphur-furnace  is  also  provided 
for  the  generation  of  sulphur  dioxide,  which  is  conveyed  into 
the  hold  of  the  adjoining  ship  after  displacement  of  the  foul  air. 

The  improved  pattern  of  sulphur-furnace  is  the  design 
of  Assistant-Surgeon  Kinyoun,  Marine-Hospital  Service,  who 
states  that  it  is  on  the  principle  of  a  reverberatory  furnace,  con- 
sisting of  a  series  of  shelves  arranged"  one  above  another,  each 
shelf  holding  a  pan  of  burning  sulphur.  A  forced  draught  is 
kept  up  by  means  of  a  fan-blower  connected  at  the  bottom. 
The  draught  of  air  charged  from  the  burning  sulphur  of  each 
shelf  is  made  to  reach  and  pass  over  the  shelf  above  by  means 
of  apertures  made  by  shortening  the  shelves  alternately  at  their 
rear  and  front  extremities.  With  an  experimental  furnace  Dr. 
Kinyoun  states  that  "repeated  experiments  gave  from  14  to  16 
per  cent,  of  S02,  temperature  21°  C,  while  burning  sulphur  in 
a  closed  place  gave  only  6  per  cent,  at  21°  C,  i.e.,  it  would  not 
support  the  combustion  of  sulphur  above  that  percentage.1 

The  furnace  belonging  to  the  fumigation  vessel  of  the 
Louisiana  Board  of  Health  is  of  a  special  pattern.  Dr. 
Salomon,  secretary  of  the  board,  states  that  for  each  vessel  201 
to  800  pounds  of  sulphur  will  be  used,  according  to  the  size  oi 
the  vessel,  and  the  fumes  will  be  allowed  to  remain  in  the  hold, 
with  hatches  sealed,  twenty-four  to  thirty-six  hours,  or  longer.2 

1  See  Abstracts  of  Sanitary  Repoi-ts,  Marine-Hospital  Service,  vol.  iii,  pages  347  and  348. 

2  See  Transactions  of  the  American  Public  Health  Association,  vol.  xiii,  for  Dr.  Holt's 
description  of  his  system,  and  vol.  xiv,  page  113,  for  Dr.  Salomon's  reports  and  improvements 
thereon. 


STEAM    DISINFECTING-CHAMBERS.  379 

The  amount  of  sulphur  used  at  the  New  York  Quarantine 
by  the  pot  method  (pots  of  burning  sulphur  lowered  into  the 
hold)  is  50  to  100  pounds,  according  to  the  vessel's  size).1 

At  Pensacola  about  12  pounds  of  sulphur  are  used  to  every 
100  tons'  register,  and  the  fumigation  lasts  twelve  hours. 

At  the  Delaware  Breakwater  4  pounds  are  used  to  each 
1000  cubic  feet  of  space,  and  the  fumes  are  kept  twenty-four 
hours  in  the  vessel's  hold.  At  Chandeleur,  35  pounds  in  hold 
to*100  tons. 

STEAM    DISINFECTING-CHAMBERS. 

The  principle  of  disinfection  by  steam  was  first  advocated 
by  Dr.  A.  N.  Bell,  of  Brooklyn,  but  the  contrivance  about  to  be 
described  was  first  used  by  Dr.  Joseph  Holt,  and  improved  by 
Dr.  Wilkinson  and  others.  These  chambers,  two  or  three  at 
one  station,  consist  of  jacketed,  cylindrical  shells,  made  of  strong 
boiler-iron,  each  shell  being  40  or  50  feet  long  and  7  or  8  feet  in 
diameter,  inside  measurement,  furnished  with  doors  at  each  end.2 

The  jacketing  is  for  the  purpose  of  using  the  chambers 
with  either  dry  heat  or  with  superheated  steam. 

Articles  of  clothing,  bedding,  etc.,  are  arranged  on  trucks, 
which  are  run  into  the  chamber  at  one  end  and  taken  out  at 
the  other.  A  bacteriological  test  made  by  Dr.  Kinyoun  at  the 
Louisiana  Quarantine  Station  showed  that  all  germs  were  killed 
after  exposure  to  a  dry  heat  of  79.4°  C,  obtained  in  sixteen 
minutes,  steam  then  being  turned  on  for  twenty  minutes.3 

Another  and  simple  contrivance  for  fumigating  is  the 
"  Liquid  Sulphurous  Dioxide,"  the  compressed  gas  furnished  in 
metal  reservoirs,  which,  being  opened,  the  gas  rapidly  escapes. 
By  this  means  any  proportion  of  S02  can  be  introduced  in  a 
vessel  without  any  apparatus.  It  is  manufactured  in  Hagenau 
and  in  Oberhausen,  Germany,  and  may  be  purchased  in  New 

1  See  Report  by  Dr.  John  H.  Ranch  upon  an  Inspection  of  the  Atlantic  and  Gulf  Quar- 
antines. State  Printer,  Springfield,  111.,  1886. 

2  See  description  under  "  Louisiana  Quarantine." 

3  For  plans  and  specifications,  see  Annual  Report  Marine-Hospital  Service  for  18S9,  and 
Abstract  of  Sanitary  Reports,  vol.  iv,  page  443.  For  Dr.  Kinyoun's  experiments,  see  Abstract 
Sanitary  Reports,  vol.  iii,  pages  117  to  147. 


380  TEST-BOOK    OF    HYGIENE. 

York,  and  of  Finlay  &  Brunswig,  wholesale  druggists,  New 
Orleans,  at  a  cost  of  five  cents  per  pound  when  not  less  than 
one  ton  is  taken.  It  has  been  suggested  that  this  may  take  the 
place  of  the  sulphur-furnace  and  appliances  on  the  steamer. 
The  cost  by  this  method  is  thought  to  be  but  little,  if  at  all, 
greater  than  by  the  furnace  method,  if  the  interest  on  the  plant 
is  added  to  the  latter.  This  method  has  been  occasionally  used 
at  the  Grosse  Isle  Quarantine,  in  Canada,  but  to  establish  its 
complete  practicability  will  require  further  test. 

ADMINISTRATION    OF   MARITIME    QUARANTINE. 

The  following  are  the  roles  and  regulations  of — 

1.  The  National  Quarantine  Stations. 

2.  State  Quarantine  Service  of  Texas. 

3.  The  Local  Quarantine  at  Pensacola,  Florida. 

In  these  three  types  will  be  found  all  the  ordinary  admin- 
istrative regulations,  which  are,  however,  subject  to  minor 
changes  yearly. 

1.  Regulations  for  the  National  Quarantine  Stations.. 

(From  the  Regulations  of  the  Marine-Hospital  Service,  1889.) 

328.  At  ports  where  quarantine  may  lie  established  by  special  statute 
or  by  the  Secretary  of  the  Treasury,  every  vessel,  before  being  permitted 
to  enter,  shall  present  to  the  Collector  of  Customs  satisfactory  evidence 
either  that  said  vessel  had  not,  at  any  time  during  a  period  of  thirty 
days  immediately  preceding  its  arrival,  touched  at  or  communicated 
with  aii3r  foreign  port  where  cholera  or  yellow  fever  exists,  or  small-pox 
was  known  to  exist  in  an  epidemic  form  ;  that  there  had  not  been  at  any 
time  during  that  period  any  ease  of  contagious  disease  on  board  ;  and 
that  said  vessel  does  not  convey  any  person  or  persons,  merchandise,  or 
animals  affected  with  any  infectious  or  contagious  disease,  or  that  the 
said  vessel  has  been  thoroughly  cleaned  and  disinfected  by  the  quarantine 
officer,  and  is  free  from  infection  at  the  time  of  entry.  The  certificate  to 
that  effect,  of  the  medical  officer  of  the  Marine-Hospital  Service,  acting 
as  quarantine  officer  for  the  United  States  at  the  port,  shall  be  accepted 
by  the  Collector  of  Customs  as  satisfactory  evidence,  end  the  medical 
officer  shall,  before  granting  such  certificate,  satisfy  himself  that  the 
matters  and  tilings  therein  stated  are  true. 

329.  Vessels  coming  from  a  foreign  port  or  country  where  cholera 


ADMINISTRATION    OF    MARITIME    QUARANTINE.  381 

* 

or  3rellow  fever  exists,  or  small-pox  is  known  to  have  existed  in  an  epi- 
demic form  within  thirty  days  preceding  their  arrival,  and  vessels  or 
vehicles  conveying  any  person  or  persons,  merchandise,  or  animals 
affected  with  any  contagions  disease,  or  having  had  on  board  at  any  time 
during  the  thirty  dajTs  preceding  their  arrival  any  case  of  contagions 
disease,  shall  not  enter  any  port  of  the  United  States  until  such  disin- 
fection or  other  precautionary  measures  shall  have  been  performed  as 
prescribed  by  these  regulations,  and  the  certificate  of  the  medical  officer 
of  the  Marine-Hospital  Service,  or  other  designated  agent  of  the  Treasury 
Department,  shall,  in  such  cases,  as  in  the  cases  referred  to  in  the  pre- 
ceding paragraph,  be  accepted  by  the  Collector  of  Customs  as  satisfactory 
evidence  of  compliance  with  the  regulations. 

330.  Quarantine  stations  will  be  governed  by  the  general  regulations 
of  the  Service,  so  far  as  applicable. 

331.  No  pilot  or  other  person  will  be  allowed  to  leave  a  vessel  until 
the  vessel  shall  have  been  inspected  by  the  quarantine  officer,  and  any 
person  violating  this  regulation  shall  be  reported  to  the  nearest  United 
States  attorney  for  prosecution  under  the  act  of  August,  1888,  and  no 
person  will  be  allowed  to  leave  the  quarantine  reservation,  or  a  vessel 
placed  in  quarantine,  without  permission  of  the  quarantine  officer. 

332.  Quarantine  officers  are  hereby  empowered  and  authorized  to 
cause  the  temporary  arrest  of  an3r  person  violating  the  quarantine  regu- 
lations, and  turn  them  over  to  the  custody  of  the  nearest  United  States 
marshal,  and  notify  the  United  States  attorney  to  that  effect ;  or,  if  that 
be  impracticable,  to  confine  them  on  the  quarantine  reservation,  subject 
to  the  orders  of  the  said  marshal  or  attorn ej7-. 

333.  When  a  vessel  arrives  at  a  United  States  quarantine  boarding- 
station,  the  inspecting  officer  will  examine  the  papers  of  the  vessel  to 
inform  himself  of  her  passengers  and  cargo;  he  will  require  all  persons 
named  on  the  passenger-list  and  crew-list  to  present  themselves  and 
answer  to  their  names  at  muster.  Should  any  person  have  died  on  the 
voyage,  the  circumstances  of  the  death  will  be  inquired  into,  and,  in  case 
of  there  being  any  person  sick,  such  person  will  be  carefully  examined 
by  the  inspecting  officer,  the  only  exception  being,  in  case  of  naval 
vessels,  the  statement  of  the  senior  surgeon  or  medical  officer  as  to  the 
sanitary  condition  of  the  vessel  will  be  accepted. 

334.  When  persons  are  found  sick  of  cholera,  small-pox,  yellow 
fever,  plague,  or  diphtheria,  they  shall  be  immediately  removed  to  the 
quarantine  hospital,  and  the  vessel  be  thoroughly  disinfected! 

335.  In  order  to  stimulate  ship-masters  to  aid  in  securing  a  clean 
ocean-going  fleet,  the  following  regulations  concerning  the  treatment  of 
foul  ships  will  be  observed  at  all  national  quarantine  stations : — 


382  TEXT-BOOK    OF    HYGIENE. 

• 

When  a  vessel  arrives  at  any  national  quarantine  station  from  an  infected  port,  and 
requires  disinfection,  she  will  be  subjected  to  ordinary  disinfection,  as  provided  in  former 
regulations. 

When  any  vessel  shall  arrive  at  a  national  quarantine  station  in  such  foul  condition 
as  to  render  her  dangerous  from  a  sanitary  point  of  view,  and  is  found  to  require  cleansing 
and  disinfection,  having  at  any  former  time  within  one  year  been  subjected  to  ordinary 
disinfection,  such  vessel  will  be  required  to  undergo  extraordinary  disinfection,  which,  in 
addition  to  the  ordinary  measures,  will  include  holy-stoning,  scraping,  the  taking  out  of 
rotten  wood,  a  second  disinfection,  and  interior  repainting,  all  of  which  will  be  required 
before  granting  a  certificate  of  free  pratique. 

336.  The  recognized  method  of  disinfection  of  vessels  will  be,  for 
all  vessels:  a,  by  bichloride  of  mercury ;  b,  by  sulphurous  oxide;  c,  by 
flushing  with  sea-water. 

337.  For  disinfection  of  clothing  and  other  fomites,  dry  heat  will 
be  used  whenever  practicable,  and  when  it  is  not  practicable  to  use  dry 
heat  the  sulphurous-oxide  fumigation  will  be  used. 

338.  The  Supervising  Surgeon-General  will  from  time  to  time  issue 
detailed  instructions  for  the  practice  of  disinfection,  under  these  regula- 
tions, which  instructions  will  include  such  improvements  as  may  be 
suggested  by  the  advance  of  science. 

2.  Quarantine  Regulations,  State  op  Texas. 
Gentral  Rules. 

No.  1.  After  the  declaration  of  quarantine  by  the  Governor,  every 
vessel,  before  entering  any  port  on  the  coast  of  Texas,  shall  be  boarded 
by  quarantine  officers,  and  the  crew  and  passengers  be  subjected  to  such 
questions  by  said  officers  as  will  be  necessary  to  determine  their  probable 
connection  with  epidemic  influence  or  infectious  diseases. 

No.  2.  Vessels  hailing  from  infected  districts,  or  having  communi- 
cated with  others  from  such  districts,  by  contact  or  otherwise,  shall  be 
placed  in  quarantine,  casting  anchor  at  such  place  or  places  as  ma}^  be 
designated  \>y  quarantine  officer  of  port,  and  a  complete  list  of  both  crew 
and  passengers  taken.  Notice  in  writing  shall  be  given  captains,  holding 
them  responsible  for  strict  non-communication  of  both  passengers  and 
crew  with  other  vessels  or  with  any  one  from  shore.  Violation  of  this 
rule  shall  be  punished  by  fine  against  vessel  and  captain,  not  less  than 
$500  or  more  than  $1000. 

No.  3.  From  the  masts  of  all  vessels  in  quarantine  shall  be  displayed 
a  yellow  flag,  of  such  dimensions  as  to  warn  off  others  approaching. 

No.  4.  All  vessels  held  in  quarantine  shall  be  under  the  direction 
of  port  quarantine  officer,  and  put  in  thorough  sanitary  condition  by  fumi- 
gation of  hold,  washing  decks  with  disinfecting  fluids,  and  purifying 
bilges,  etc. 


ADMINISTRATION    OF    MARITIME    QUARANTINE.  383 

Xo.  5.  Costs  of  fumigation,  disinfection,  etc.,  shall  be  at  expense  of 
vessels. 

Xo.  6.  A  complete  muster  of  crew  and  passengers  must  again  be 
taken  before  vessels  are  given  free  pratique,  and  a  concise  report  made 
to  State  health  officer.  Xo  vessel  shall  be  finally  released  without  per- 
mission of  State  health  officer. 

Xo.  7.  Families  of  quarantine  officers  will  not  be  allowed  at  stations 
without  special  permission  from  State  health  officer  during"  the  existence 
of  quarantine. 

Pilots. 

Pilots  will  not  be  allowed  to  visit,  or  board,  or  communicate  with 
any  vessels  without  permission  of  port  quarantine  officer,  under  penalty 
of  forfeit  of  their  commissions  as  such. 

Market  Vessels. 

Market  vessels — meaning  those  which  belong  at  the  port,  and  which 
furnish  daily  supplies  to  vessels  at  anchor  or  in  quarantine — shall,  in 
every  instance,  apply  to  quarantine  officer  for  permission  before  attempt- 
ing to  trade  or  communicate  with  such  vessels  ;  and  in  case  of  violation 
of  this  rule  shall  themselves  be  placed  in  quarantine  and  held  at  discre- 
tion of  officer  in  charge. 

Vessels  with  Cargo  to  be  Disinfected. 

Any  vessels  from  infected  districts  which  may  desire  to  enter  such 
cargo  shall,  upon  arrival  at  outer  bar,  make  known  their  intention  to 
quarantine  officer.  Quarantine  officers  receiving  this  cargo  at  quarantine 
warehouse  shall  employ,  as  far  as  possible,  only  acclimatized  men,  and 
said  employes  shall  be  kept  under  quarantine  themselves  a  sufficient 
number  of  days  to  determine  their  probable  infection,  their  clothing  and 
other  articles  capable  of  conve^'ing  infection  be  subjected  to  a  high  tem- 
perature, say  220°  F.  (105°  C),  before  being  allowed  to  return 'to  cities 
or  shore.  The  crews  of  said  vessels  shall  be  subject  to  rules  as  above, 
and  such  other  precautions  as  may  be  deemed  requisite  at  the  time  by 
State  health  officer.  Costs  in  this  instance,  as  in  others,  are  chargeable 
to  owners  of  cargoes. 

3.  Quarantine  Eegulattons  at  Pensacola,  Florida. 

(Issued  by  the  Escambia  County  Board  of  Health.) 

1.  The  port  inspector  shall  visit  and  inspect  every  vessel  entering 
the  bay  of  Pensacola,  and  ascertain  and  report  her  sanitary  condition  ; 
and  until  such  inspection  and  report,  and  the  release  of  such  vessel  by 
said  officer,  no  person  shall  visit  her,  and  no  person  from  her  shall  visit 


384  TEXT-BOOK    OF   HYGIENE. 

any  other  vessel  or  the  shore.     The  master  or  owner  of  each  vessel  so 
inspected  shall  pay  to  this  Board  for  such  services  $5. 

2.  No  vessel  coming  into  the  port  of  Pensacola,  having  on  board 
any  contagious  or  infectious  disease,  or  from  a  port  where  any  such  dis- 
ease prevails,  shall  remain  within  the  territory  under  the  jurisdiction  of 
this  Board,  except  at  a  point  designated  and  under  restrictions  imposed 
by  this  Board,  according  to  the  exigencies  of  each  case. 

3.  It  shall  he  the  duty  of  any  person  coming  into  the  count}T  of 
Escnmbia  or  port  of  Pensacola,  from  any  locality  where  any  disease  in 
an  epidemic  form  prevails,  to  report  at  once  to  this  Board  or  some  officer 
thereof,  and  no  person  coming  from  any  such  localit}*  shall  remain  in  said 
count}'  without  the  permit  of  this  Board,  and  then  only  at  such  point  as 
may  be  designated,  and  under  such  restrictions  as  may  be  imposed  by 
this  Board,  according  to  the  exigencies  of  each  case. 

4.  Xo  ballast  brought  into  the  bay  of  Pensacola  by  ATessels  shall  be 
discharged  in  the  county  of  Escambia,  or  the  waters  separating  that 
county  and  the  county  of  Santa  Rosa,  except  at  such  point  as  may  be 
designated  in  a  permit  obtained  from  this  Board  or  granted  on  its 
authority  ;  and  in  case  this  Board  or  its  sanitary  inspector  or  other 
officer,  with  approval  of  this  Board,  deem  it  expedient  for  the  preserva- 
tion of  the  public  health  to  require  fumigation,  disinfection,  or  discharge 
of  ballast  at  quarantine  station,  the  same  shall  be  done  at  the  expense  of 
the  vessel,  and  in  accordance  with  the  system  in  use  Ity  this  Board. 

5.  All  pilots  and  tow-boats  of  the  port  of  Pensacola  shall  be  sup- 
plied with  copies  of  these  rules,  and  every  pilot  or  tow-boat  master  speak- 
ing or  boarding  a  vessel  coming  into  said  port  shall  hand  a  copjr  thereof 
to  the  master  of  said  vessel. 

6.  In  case  any  vessel  shall  be  required,  by  authority  of  this  Board 
in  the  exercise  of  its  powers  to  preserve'  the  public  health,  to  discharge 
ballast  at  quarantine  station  or  be  fumigated,  she  shall  pay  25  cents  per 
ton  for  the  ballast  discharged,  and  for  the  fumigation  shall  pay  as  follows  : 
Steam-ships,  $75  ;  ships,  $50  ;  barks  and  other  vessels  other  than  brigs 
and  two-masted  schooners,  $40  ;  brigs,  $20  ;  two-masted  schooners,  $15. 

7.  Xo  pilot,  tow-boatman,  or  other  person  shall  remove,  transfer, 
or  receive,  or  assist  in  removing,  transferring,  or  receiving  an}r  person 
from  any  vessel  entering  the  bay  of  Pensacola  until  such  vessel  shall 
have  been  inspected  and  released  \>y  the  port  inspector. 

QUARANTINE    PRACTICE. 

The  practical  duties  of  administration,  particularly  the 
inspection  and  treatment  of  vessels,  are  well  described  by  the 


QUARANTINE    PRACTICE.  385 

medical  officers  in  command  of  the  several  stations  named  in 
the  following  letters  : — 

Gulf  Quarantine  Station,  Chandeleur  Island,  Miss. 

(Letter  from  P.  A.  Surgeon  H.  R.  Carter,  U.  S.  M.-H.  S.) 

I  board  the  incoming  vessel  while  under  way  and  give  her  such  a 
berth  as  in  m}' judgment  is  suitable. 

When  she  is  at  anchor  I  first  examine  her  papers,  bills  of  health, 
crew-list,  and  log  ;  questioning  the  master  at  the  same  time  on  such  points 
as  may  bear  on  the  sanitary  condition  of  his  vessel ;  and,  except  in  the 
case  of  Dr.  Burgess's  papers,  given  at  Havana,  far  more  valuable  infor- 
mation will  be  given  by,  or  may  be  extracted  from,  the  master  than  is 
conveyed  by  the  bills  of  health.  The  master  is  asked  how  long  he  kty  at 
the  port  of  clearance,  especially  where  he  discharged  and  where  he  lay ; 
there  being,  for  instance,  as  much  difference  in  the  liability  to  infection 
between  different  wharves  in  Havana,  or  between  the  Gamboa  and  the 
Coal  Islands  in  Rio,  as  between  different  ports. 

I  especially  ask  for  the  cause  of  discharge  of  men  left  (generally  in 
hospital)  at  the  port  of  clearance,  and  mark  the  substitutes  shipped  there 
for  special  examination.  These  men  having  probably  been  ashore  for 
some  time  and  quite  frequently  just  out  of  hospital,  where  they  were  left 
by  other  vessels,  are  occasionally  the  means  of  introducing  3Tellow  fever 
aboard  a  vessel  healthy  until  they  are  shipped. 

The  statements  of  the  master  and  even  the  log  (except  in  British 
vessels)  are  naturally  to  be  taken  with  some  "  personal  correction  " 
dependent  on  circumstances,  and  which  has  wide  limits.  In  general,  I 
think  intentional  false  statements  are  extremely  rare,  but  statements  of 
damaging  facts  may  not  readily  be  volunteered. 

The  vessel  is  then  inspected.  I  go  all  over  it,  into  ever}'-  place, 
noting  especially  the  sleeping-places  and  bedding,  water-closets,  character 
of  ballast,  and  condition  of  the  hold  and  forecastle,  as  regards  cleanliness, 
ventilation,  and  dryness  ;  whether  the  air  streaks  are  open  ;  if  the  ports 
have  been  open  recently,  or  the  wind-sails  show  signs  of  recent  use.  In 
the  hold,  aft  and  forward  are  most  apt  to  be  dirty.  If  the  ballast  has 
been  recently  trimmed  and  the  crew  is  healthy  it  is  a  good  sign  ;  on  the 
other  hand,  it  may  account  for  a  sudden  outbreak  of  fever  after  she  puts 
to  sea,  in  a  ship  previously  healthy. 

The  bilge  is  examined  by  pumping,  if  in  ballast ;  by  lifting  a  timber- 
plank  if  not ;  and  on  the  smell  more  stress  is  laid  than  on  the  coloi*. 

I  inspect  the  ship  before  I  do  the  ci-ew,  so  that  I  ma}r  see  the  crew 
when  the}r  are  not  aware  they  are  under  observation.  I  then  inspect  the 
crew.     All  stand  together,  and  as  I  call  the  roll  each  man  answers, 


386  TEXT-BOOK    OF    HYGIENE. 

comes  to  me,  and  passes  to  another  place.  Any  I  wish  to  examine  more 
closely  are  told  to  step  aside.  These  would  in  general  he  :  Those  who 
look  sick,  or  as  if  they  had  heen  sick ;  those  who  by  the  log  or  master's 
statement  had  been  sick ;  those  who  had  shipped  at  port  of  clearance. 
They  are  examined  as  may  be  deemed  necessary.  In  these  cases  little 
dependence  can  be  placed  on  the  accounts  sailors  give  of  their  past  ail- 
ments, and  a  kind  of  inverse  malingering  is  universal.  For  instance,  the 
cabin-boy  of  the  "Maria,"  with  yellow  fever,  was  standing  up,  although 
holding  by  a  chair,  and  reported  himself  as  perfectly  well  and  "  could  eat 
much,"  then  staggered  and  had  fallen  had  I  not  caught  him  in  my  arms, 
vomiting  as  he  fell. 

"We  have  no  cargoes,  save  occasionally  a  schooner  with  fustic,  log- 
wood, or  sisal. 

The  baggage  is  examined  when  unpacked  for  disinfection. 

If  the  vessel  is  infected  and  has  sick  men  aboard,  I  attend  to  the 
sick  first,  and  remove  them  if  possible.  Right  here  I  may  say  that  in 
some  stages  of  }*ellow  fever  removal  is  not  possible  with  safety  to  the 
patient — it  means  death  to  him.  In  this  event,  he  should  be  isolated  on 
board  ship,  having  already  had  the  disease  two  or  three  da}rs,  and  thereby 
having  already  exposed  the  vessel.  As  soon  as  possible,  however,  he 
should  be  removed. 

A  preliminary  fumigation  and  disinfection  is  done  immediately 
before  doing  anything  else,  in  the  hope  of  destroying  the  contagium  at 
its  source,  and  preventing  the  sickness  of  others  of  the  crew.  This  is 
done  as  thoroughly  as  possible  without  removing  ballast  or  much  prelimi- 
nary mechanical  cleaning,  but  particular  attention  being  given  to  the 
probable  source  of  infection.  The  vessel  is  then  treated  in  the  routine 
manner,  as  follows  : — 

The  bilge  is  first  pumped  out  and  washed  until  clean,  after  which 
the  disinfectant  is  put  in, — generally  bichloride  of  mercury.  At  Chande- 
leur  we  have  practically  no  cargoes  to  deal  with.  The  ballast  therefore 
is  next  removed.  All  sand,  earth,  porous  stone,  or  other  foul  ballast  is 
removed — thrown  overboard.  The  work  is  done  by  the  ship's  crew. 
Clean,  sharp  stone — as  much  as  may  be  necessary  to  hold  the  vessel,  i.e., 
prevent  her  capsizing — may  be  allowed  to  remain,  each  stone  having 
been  immersed  in  a  1  to  800  solution  of  bichloride  of  mercury.  This  is 
done  by  the  crew  while  trimming  ballast, — a  necessar}"  procedure,  irre- 
spective of  disinfection.  The  hold  is  washed  down  with  sea-water  by 
means  of  a  force-pump,  birch  and  whalebone  brooms  being  also  used,  and, 
if  necessary,  scrapers.  The  same  is  done  to  the  forecastle  and  other 
parts,  if  necessary. 

The  vessel  being  mechanically  clean  in  its  accessible  portions,  the 


QUARANTINE   PRACTICE.  387 

disinfection  is  begun.  All  soiled  or  used  clothing,  and  all  bedding  that 
can  be  so  treated  'without  destruction,  is  soaked  for  half  an  hour  in 
bichloride  solution.  The  remainder  is  hung  up  loosely  for  fumigation. 
Not  unfrequently  there  are  articles — cotton-stuff  comforts,  etc. — which 
cannot  be  disinfected,  and  are,  therefore,  destroyed.  All  articles  not 
capable  of  conveying  infection,  as  chronometers  and  articles  made  from 
the  precious  metals,  are  removed.  The  cabin,  forecastle,  and  hold  are 
then  fumigated.  For  close  vessels  the  amount  of  sulphur  used  in  the 
hold  is  35  pounds  per  100  tons.  The  cabin  and  forecastle  are  kept 
closed  twenty-four  hours,  the  hold  from  forty-eight  to  sevent}^-two  hours. 
In  an  ordinarily  tight  ship  it  is  impossible  to  enter  the  hold,  even  after 
sevent}*-two  hours,  until  the  fumes  have  been  displaced  by  air  from  wind- 
sail  and  open  ports.  When  the  doors  are  opened  all  surfaces  are  washed 
■with  a  solution  of  bichloride,  either  with  hose  and  brooms  or  with  mops. 
Gilt-work,  being  utterly  destroyed  by  this  agent,  is  washed  with  water  as 
near  boiling  as  it  can  be  used. 

The  quarantine  detention  of  the  vessel  now  begins.  The  proper 
time  in  quarantine  is  not  less  than  the  period  of  incubation.  The  number 
of  days  of  passage  from  foreign  ports  counts  for  nothing,  as  does  also 
the  time  on  the  quarantine  grounds  previous  to  completion  of  dis- 
infection. 

In  estimating  the  probability  of  a  vessel  being  infected,  it  makes 
quite  a  difference  whether  the  yellow  fever  she  has  had  in  passage  devel- 
oped at  such  time  that  it  could  have  been  contracted  elsewhere  than  on 
board  ship,  or  so  long  after  clearing  as  of  necessity  to  have  been  com- 
municated by  the  ship  or  fomites  aboard  her.  In  the  latter  case  she  was 
infected.     This  has  a  direct  bearing  on  her  treatment. 

South  Atlantic  Quarantine  Station,  Blackbeard  Island,  Ga. 

(Description  of  Quarantine  Methods,  by  Passed-Assistant-Surgeon  J.  H.  White,  U.S.M.-H.S.) 

On  boarding  a  newly-arrived  vessel,  I  first  demand  the  crew-list  and 
passenger-list  (if  any).  I  have  the  roll  called,  and,  when  all  have 
answered,  inspect  each  and  every  person,  with  a  view  to  the  discover}-  of 
any  signs  of  present  or  recently -passed  sickness,  of  any  character. 

The  cabin,  forecastle,  galley,  and  any  other  rooms  are  then  in- 
spected, and  every  chest  and  locker  opened  and  contents  seen. 

The  hold  and  between  decks  are  next  inspected.  All  sick  are 
removed  to  hospital. 

This  constitutes  the  first  step. 

The  second  consists  in  putting  into  all  these  places  a  preliminary 
fumigation  with  sulphur  of  sufficient  quantity,  this  process  occupy  in  »• 
about  twenty-four  hours. 


388  TEXT-BOOK    OF    HYGIENE. 

Tlrird. — All  ballast  is  removed  when  possible,  and  when  not  so  it 
is  dipped  stone  by  stone  in  bichloride  solution  of  the  strength  of  1  to  300 
or  1  to  500,  and  the  whole  vessel  is  washed  as  clean  as  water  can  make 
her, — hold,  deck-houses,  and  all. 

Fourth. — Another,  and  even  stronger  fumigation  than  the  first, 
with  sulphurous-acid  gas. 

Fifth. — With  a  force-pump  and  hose,  a  solution  of  bichloride 
(1  to  500.  or  stronger)  is  freely  applied  to  every  part  of  ship  and  con- 
tents. Clothing,  both  in  use  and  not,  is  either  burned,  boiled,  or  soaked 
in  a  1  to  500  solution  of  bichloride ;  sometimes  both  the  latter  measures. 
Soaking  lasts  ten  to  fifteen  minutes.  Clothing  is  boiled  twenty  minutes; 
bedding  two  to  three  hours.  Bedding  is  most  often  burned,  and  always 
after  small-pox. 

Delaware  Breakwater  Quarantine  Station. 

(Inspection  and  Treatment  of  Vessels,  by  "Wedliam  P.  Ore,  A.  A.  Surgeon  TJ.  S.  M.-H.  S.) 

The  plan  which  I  have  followed  in  inspecting  vessels  at  this  station 
is  as  follows: — 

I  first  go  down  into  the  cabin  and  examine  the  bill  of  health  (and 
manifest,  if  the  vessel  has  a  general  cargo).  From  these  I  learn  the 
following  important  facts  :  The  sanitaiy  condition  of  the  port  of  depart- 
ure at  the  time  of  sailing ;  the  date  of  departure ;  number  of  crew  and 
passengers,  and  whether  the  vessel  sails  in  quarantine  or  free  pratique. 
I  will  say  just  here  that  the  bills  of  health  issued  by  Dr.  Burgess,  an 
Inspector  of  the  Marine-Hospital  Service,  stationed  at  Havana,  are  the 
most  complete  and  satisfactory  bills  of  health  that  I  examine,  and  we 
have  vessels  coming  to  the  Breakwater  from  all  over  the  world.  He 
always  gives  the  sanitary  histoiy  and  condition  of  the  vessel,  cargo, 
crew,  and  passengers,  and  the  number  of  cases  and  number  of  deaths 
from  contagious  diseases  during  the  week  previous  to  the  departure  of 
the  vessel. 

If  on  arrival  there  is  no  sickness  on  the  vessel,  and  there  has  been 
none  during  the  passage,  and  there  is  no  infectious  or  contagious  disease 
at  the  port  whence  she  sails,  then  the  vessel  is  discharged  from  quaran- 
tine. If  there  is  anj^  contagious  disease  on  board  on  arrival,  the  sick 
are  brought  ashore  and  cared  for  in  hospital,  and  the  vessel  fumigated, 
disinfected,  and  detained  for  a  variable  period,  usually  ten  days,  in  order 
to  observe  the  crew  and  see  whether  an}1"  new  cases  are  going  to  appear. 
If  the  crew  are  all  well  on  arrival,  but  have  had  sickness  (\>y  sickness  I 
mean  yellow-fever,  small-pox,  or  cholera)  during  the  passage,  the  vessel 
receives  the  same  treatment  as  above.  In  case  the  crew  are  all  well,  and 
there  has  been  no  sickness  during  the  passage,  but  the  vessel  comes  from 


SPECIAL    MEASURES   AGAINST    CHOLERA.  389 

an  infected  port,  then  the  treatment  of  the  vessel  depends  upon  the 
number  of  days'  passage,  the  condition  of  the  vessel,  the  statement  of 
the  captain  (which  is  made  under  oath)  as  to  whether  the  crew  were 
allowed  to  visit  the  shore,  and  the  length  of  time  the  vessel  was  in  port 
discharging  the  cargo  and  reloading,  and  other  considerations  which 
enable  us  to  decide  whether  any  danger  need  be  apprehended  in  allowing 
the  vessel  to  enter.  After  careful  inspection  of  a  vessel  from  an  infected 
port,  if  I  find  everything  neat  and  clean,  I  usually  allow  her  to  proceed, 
provided  she  has  had  a  passage  of  ten  days  or  more ;  but  if  she  has  not 
been  out  for  that  length  of  time  I  detain  the  vessel,  during  the  summer 
season,  for  observation  until  the  ten  days  from  date  of  departure  have 
expired.  At  the  end  of  this  time,  if  no  sickness  appear,  the  vessel  is 
discharged. 

To  clean  an  infected  vessel,  we  begin  the  first  day  by  fumigating, — 
that  is,  burn  about  4  pounds  of  sulphur  for  every  1000  cubic  feet 
of  air-space,  the  hatchways,  doors,  and  windows  being  closed  and 
caulked,  so  as  to  make  the  hold,  cabin,  and  forecastle  as  nearly  air-tight 
as  possible.  The  sulphur-fumes  are  allowed  to  remain  in  the  hold  twenty- 
four  hours,  and  in  the  cabin  and  forecastle  about  ten  hours ;  the  second 
day  all  beds,  pillows,  and  furniture  which  cannot  be  satisfactorily  disin- 
fected are  burned,  and  all  clothing,  blankets,  curtains,  carpets,  and  cotton 
and  woolen  goods  are  soaked  in  a  bichloride  solution  (1  to  2000).  The 
third  day  the  floors,  walls,  and  ceilings  of  the  cabin  and  forecastle,  and 
all  furniture,  drawers,  and  chests  in  them  washed  with  the  same  solution. 
The  vessel  is  now  supposed  to  be  clean,  and  is  discharged  at  once,  pro- 
vided the  average  period  of  incubation  for  the  disease  from  which  the 
crew  have  suffered  has  elapsed  since  there  was  any  one  sick  on  board. 

SPECIAL   MEASURES   AGAINST    CHOLERA. 

Other  features  of  quarantine  administration  are  well  ex- 
pressed in  the  following  extract  from  the  editorial  pages  of  the 
Philadelphia  Medical  News  of  October  15,  1887,  showing  the 
measures  necessary  to  extinguish  an  incipient  epidemic  of  cholera 
and  to  prevent  its  spread.     Such  measures  are  as  follow : — 

(a)  Speedy  recognition  and  isolation  of  the  sick ;  their  proper 
treatment ;  absolute  and  rapid  destruction  of  the  infectious  agent  of  the 
disease,  not  only  in  the  dejecta  and  vomit,  but  also  in  clothing,  bedding, 
and  in  or  upon  whatever  else  it  finds  a  resting-place. 

(6)  The  convalescents  should  remain  isolated  from  the  healthy  so 
long  as  their  stools  possibly  contain  any  of  the  infecting  agent ;  before 


390  TEXT-BOOK   OF   HYGIENE. 

mingling  again  with  the  well  they  should  be  immersed  in  a  disinfecting 
bath,  and  afterward  be  clothed  from  the  skin  outward  with  perfectly 
clean  vestments,  which  cannot  possibly  contain  any  of  the  infectious 
material. 

(c)  The  dead  should  be  well  wrapped  in  cloth  thoroughly-  saturated 
in  a  solmtion  of  corrosive  sublimate  (1  to  500),  and,  without  delay,  cortege, 
or  lengthy  ceremonial,  buried  near  the  place  of  death  in  a  deep  grave,  re- 
mote as  possible  from  water  whicli  may,  under  any  circumstances,  be  used 
for  drinking,  washing,  culinary  or  other  domestic  purposes.  (Cremation, 
of  course,  is  by  far  the  safest  way  of  disposing  of  cholera  cadavers.) 

(d)  Those  handling  the  sick  or  the  dead  should  be  careful  to  dis- 
infect their  hands  and  soiled  clothing  at  once,  and  especially  before  touch- 
ing articles  of  food,  drinking,  or  culinary  vessels. 

(e)  In  the  case  of  maritime  quarantine,  the  well  should  be  disem- 
barked and  placed  under  observation  in  quarters  spacious  enough  to 
avoid  crowding,  and  so  well  appointed  and  furnished  that  none  will  suffer 
real  hardships. 

(f)  Once  having  reached  the  station,  those  under  observation 
should  be  separated  in  groups  of  not  more  than  twelve  to  twentj^-four, 
and  the  various  groups  should,  under  no  pretext,  intermingle.  The  quar- 
ters for  each  group  should  afford  stationary  lavatories  and  water-closets 
in  perfect  working  condition,  adequate  to  the  needs  of  the  individuals 
constituting  the  group,  and  supplied  with  proper  means  of  disinfection. 
There  should  be  a  bed  raised  above  the  floor,  proper  coverings,  and  a 
chair  for  each  member  of  the  group,  each  person  being  required  to  use 
only  his  own  bed.  There  should  be  a  common  table  of  sufficient  size  to 
seat  around  it  all  the  members  of  the  group,  who  shoidd  be  served  their 
meals  from  a  central  kitchen,  and  with  table  furniture  belonging  to  the 
station  and  cleaned  by  the  common  kitchen  scullions. 

(g)  Drinking-water,  free  from  possible  contamination  and  of  the 
best  quality,  should  be  distributed  in  the  quarters  of  each  group  as  it  is 
needed,  and  in  such  a  manner  that  it  is  received  in  drinking-cups  only. 
There  should  be  no  water-buckets  or  other  large  vessels  in  whicli  hand- 
kerchiefs, small  vestments,  children's  diapers,  etc.,  can  be  washed  by  the 
members  of  any  group. 

(h)  Immediately  after  being  separated  into  groups  in  their  respec- 
tive quarters,  every  person  under  observation  should  be  obliged  to  strip 
and  get  into  a  bath  (a  disinfecting  one  is  preferable),  and  afterward  be 
clothed  with  fresh,  clean  vestments  from  the  skin  outward.  Every  article 
of  clothing  previously  worn  should  be  taken  awaj*-  and  properly  disin- 
fected. 

(i)  Then  all  of  the  personal  effects  should  be  at  once  removed  to  a 


SPECIAL   MEASURES    AGAINST    CHOLERA.  391 

separate  building,  washed  (if  possible),  and  thoroughly  disinfected,  or, 
if  necessaiy,  destroyed.  After  disinfection  they  should  be  temporarily 
returned  to  the  members  of  groups,  when  occasion  requires  a  further  change 
of  clothing. 

(k)  Under  no  circumstances  whatever  should  washing  of  clothing 
by  those  under  observation  be  permitted.  All  used  clothing  should  be 
first  thoroughly  disinfected  (by  boiling,  when  possible), and  then  should 
be  cleansed,  the  disinfection  and  washing  being  done  by  a  sufficiently 
trained  and  absolutely  reliable  corps  of  employes  supplied  with  adequate 
appliances. 

(I)  All  those  under  observation  should  be  mustered  in  their  own 
quarters,  and  be  subjected  to  a  close  medical  inspection,  while  on  their' 
feet,  at  least  twice  every  day,  in  order  to  discover  and  isolate,  as  soon  as 
possible,  new  cases  which  ma}r  develop ;  and,  of  course,  the  clothing  and 
bedding  of  these  new  cases  should  be  treated  without  delay  in  the  manner 
already  mentioned.  In  the  meantime,  a  watch  should  be  set  over  the 
water-closets  for  the  purpose  of  discovering  cases  of  diarrhoea,  and,  when 
discovered,  such  cases  should  be  temporarily  separated  from  the  rest. 
They  should  receive  judicious  medical  attention  at  once,  and  precautions 
should  be  taken  as  if  they  were  undoubted  but  mild  cases  of  cholera. 

(m)  The  quarters  should  be  kept  thoroughly  clean,  and  every  sur- 
face upon  which  infectious  material  could  possibly  be  deposited,  includ- 
ing the  floors,  should  be  washed  with  a  strong  disinfectant  twice  daily, 
and  oftener  when  necessary.  Evacuations  from  the  bowels  should  be 
passed  into  a  strong  disinfectant ;  the  hopper  of  the  closet  should  be 
then  flushed  and  finally  drenched  with  a  quantity  of  the  same  dis- 
infectant. 

(n)  For  the  proper  attention  to  the  sick,  there  should  be  two  or 
more  competent  and  experienced  physicians,  assisted  by  a  sufficient  corps 
of  intelligent  and  efficient  nurses,  with  hours  of  duty  so  arranged  that  a 
physician,  with  a  sufficient  number  of  nurses,  be  in  constant  attendance 
in  the  wards  of  the  hospital. 

(o)  For  the  prompt  recognition  and  separation  of  new  cases,  their 
temporary  medical  attention,  the  proper  treatment  of  discovered  cases 
of  diarrhoea  or  cholerine  and  of  other  maladies,  and  the  immediate  cor- 
rection of  every  insanitary  practice  or  condition  by  constant,  vigilant,  and 
intelligent  supervision,  there  should  be  at  least  two  or  more  competent 
and  experienced  physicians,  with  hours  of  service  so  arranged  that  a  phy- 
sician is  on  duty  night  and  day  among  those  under  observation ;  and  he 
should  have,  subject  to  his  orders  at  any  and  everj^  moment,  a  sufficient 
and  efficient  corps  of  nurses  and  laborers  to  carry  out  properly  and 
promptly  his  directions. 


392  TEXT-BOOK  of  hygieist:. 

(p)  In  order  to  prevent  the  intermingling  of  the  various  groups,  to 
enforce  obedience  and  order,  and  to  make  it  absolutely  impossible  for  the 
quarantined  and  their  personal  effects  to  have  any  communication  with 
the  exterior,  a  well-organized  and  sufficiently  large  police  corps  should 
patrol  the  borders  of  the  stations  and  the  buildings  day  and  night. 

(q)  Any  group  among  whom  there  have  developed  no  new  cases  of 
cholera  or  of  choleraic  diarrhoea,  during  the  preceding  eight  or  ten  days, 
ma}'  be  regarded  as  harmless,  and  allowed  to  leave  quarantine  after  each 
one  is  finally  immersed  in  a  disinfecting  bath  and  re-clothed  with  clean 
garments  from  the  skin  outward,  the  garments  removed  being  destroyed 
or  thoroughly  disinfected  and  cleansed,  as  already  indicated. 

As  yet  no  reference  has  been  made  to  the  crew,  ship,  and  cargo. 
"What  has  been  said  of  the  treatment  of  those  under  observation  applies 
to  every  one  of  the  ship's  inhabitants.  The  observation,  isolation,  and 
cleansing  of  the  crew  and  their  effects  could  safely  be  performed  aboard 
ship  if  necessary.  The  ship  should  be  thoroughly  cleansed  and  disin- 
fected, particular  attention  being  given  to  the  quarters  of  the  emigrants 
and  crew. 

AIDS    TO    QUARANTINE. 

In  aid  of  the  national  quarantines,  sanitary  inspectors  are 
appointed  by  the  Marine-Hospital  Service  at  special  points  of 
danger,  either  in  the  United  States  or  abroad.  Through  the 
State  Department  consular  notification  from  foreign  ports  is 
received  regularly  by  mail.  or.  in  emergency,  by  cable,  and  the 
information  thus  received,  and  that  received  also  from  home 
ports,  is  communicated,  by  the  Ma  line-  Hospital  Bureau,  to  all 
quarantine  authorities  and  others,  by  means  of  a  weekly  publi- 
cation known  as  the  "Abstract  of  Sanitary  Reports." 

An  important  source  of  information  concerning  the  move- 
ments of  vessels  in  every  portion  of  the  world  is  the  "Maritime 
t  Register,"  published  in  Xew  York.  The  United  States  Col- 
lectors of  Customs  are  efficient  aids,  having,  by  law,  the  power 
of  search  and  detention  of  vessels,  and  having  exceptional 
knowledge  of  the  sanitary  condition  of  the  shipping  at  their 
respective  ports.  The  Revenue-Cutter  Service,  a  national  coast 
patrol,  renders  efficient  aid.  and  the  light-house  establishment 
and  coast  survey  render  valuable  assistance  in  locating  and 
buoying  the  anchorages. 


INLAND   QUARANTINE.  393 

Finally,  the  Marine-Hospital  Service,  having,  besides  the 
quarantines,  the  care  of  the  sick  of  the  merchant  vessels  of  the 
United  States,  with  126  physicians  stationed  at  all  the  larger 
and  many  of  the  smaller  ports,  is  ready  at  a  moment's  notice  to 
extend  indefinitely  its  quarantine  service.  To  the  surgeon- 
general  of  this  service,  at  Washington,  are  entrusted  all  national 
quarantine  matters. 

INLAND    QUARANTINE. 

Under  Inland  Quarantine  will  be  mentioned  The  Sanitary 
Cordon,  Camps  of  Probation,  Railroad  Quarantine,  Disinfection 
Stations,  and  Inspection  Service. 

The  Sanitary  Cordon. — This  consists  of  a  line  of  guards, 
military  or  civil,  thrown  around  a  district  or  locality,  either  to 
protect  the  same  from  the  surrounding  country  when  infected, 
or  to  protect  the  surrounding  country  from  the  infected  district 
or  locality.  When  a  given  locality  is  infected,  and  the  adjacent 
territory  is  regarded  as  suspicious,  it  may  be  necessary  to  establish 
a  double  cordon,  the  first  one  embracing  the  whole  suspected 
territory  at  its  outer  edge,  the  second  investing  more  closely  the 
well-defined  infected  locality.  After  the  expiration  of  a  sufficient 
time  to  prove  that  the  area  between  the  cordons  is  not  infected, 
or  has  been  cleared  of  infection,  the  first  cordon  may  be  re- 
moved. Hospitals  and  camps  of  probation  may  be  necessary 
adjuncts  to  the  cordon.  The  most  noted  example  of  the  sanitary 
cordon  is  found  in  the  history  of  the  plague  epidemic  in  Russia 
in  1878.  A  colony  on  the  river  Volga,  called  Wetljankaja,  with 
a  population  of  1700  inhabitants,  became  infected  with  the 
Oriental  plague,  which  extended  to  the  neighboring  villages.  A 
military  cordon  was  made  to  embrace  all  the  infected  district. 
The  inhabitants  of  the  focus  of  infection,  Wetljankaja,  were 
removed,  property  appraised  for  re-imbursement  by  the  govern- 
ment, and  the  village  burned.  An  additional  cordon  was  thrown 
around  Zarizin,  a  neighboring  commercial  city  of  importance 
and  terminus  of  the  Russian  railway  system.  The  cordons  were 
maintained  several  months,  and  the  plague  was  stamped  out. 


394  TEXT-ROOK   OF   HYGIENE. 

(See  Abstract  Sanitary  Reports,  vol.  i  [Bulletin's],  page  78.) 
The  sanitary  cordon  is  the  customary  method  of  preventing  the 
spread  of  epidemic  disease  in  the  eastern  countries. 

In  the  United  States,  when  yellow  fever  prevailed  in  Pen- 
sacola  in  1882,  to  the  extent  of  2200  cases,  the  navy-yard 
reservation,  whose  boundary-line  is  within  two  miles  of  the  city 
limit,  with  a  population  of  about  1500,  was  successfully  guarded 
by  means  of  a  cordon  and  non-intercourse. 

The  following  year,  1883,  the  navy=yard  itself  was  infected, 
and  a  cordon  was  thrown  around  it  to  protect  the  city  of  Pen- 
sacola,  and  was  maintained  for  a  period  of  sixty  days.  This 
cordon  was  under  the  management  of  the  Surgeon-General  of  the 
Marine -PI  ospital  Service,  aid  having  been  requested  of  the  na- 
tional government.  The  Collector  of  Customs  of  Pensacola 
was  made  the  agent  to  execute  the  orders  of  the  Marine-Hospital 
Bureau,  and  to  the  president  of  the  local  Board  of  Health  was 
entrusted  the  immediate  command  of  the  line  and  guards.  The 
cordon  entirely  surrounded  the  land  boundary  of  the  naval 
reservation.  Its  line  was  four  miles  in  length,  one  mile  of  it 
through  a  dense  thicket,  and  was  marked  by  blazed  trees  and 
flags.  Forty  men  were  employed  as  guards,  an  equal  number 
being  selected  from  each  of  the  two  political  parties.  Two  cap- 
tains were  appointed,  and  were  obliged  to  supervise  the  line 
night  and  day. 

The  sentinel  posts  were  furnished  with  tents,  and  two  guards 
were  allotted  to  each  post,  taking  alternate  watches  of  four 
hours  each.  A  detention  or  probation  camp  was  established 
and  placed  in  charge  of  a  physician,  where  persons  wishing  to 
leave  the  reservation  were  obliged  to  pass  a  probationary  period 
of  twenty  days.  Not  more  than  half  a  dozen  persons  were 
received  in  this  camp.  The  government  expended  about 
$20,000  in  these  restrictive  measures,  which  were  entirely  suc- 
cessful. Not  one  person  got  through  the  cordon  line.  The 
success  was  due  largely  to  the  thorough  discipline  maintained 
by  the  Collector  and  the  President  of  the  Board  of  Health. 


INLAND    QUAKANTINE.  395 

Yellow-Fever  Cordon  in  Texas. — In  1882,  yellow  fever  pre- 
vailing in  Mexico  along-  the  Rio  Grande,  and  in  Brownsville, 
Texas,  a  sanitary  cordon  was  established  by  the  Surgeon-General 
of  the  Marine-Hospital  Service,  on  request  of  the  Governor  of 
the  State,  extending  along  the  line  of  the  railroad  from  Corpus 
Christi,  on  the  Gulf  of  Mexico,  inland  to  Laredo,  on  the  Rio 
Grande.  This  line  was  180  miles  northeast  of  Brownsville,  the 
triangular  territory  thus  hemmed  in  by  the  cordon  on  one  side, 
the  Bio  Grande  on  another,  and  the  Gulf  on  the  third,  being  all 
suspected  territory,  although  the  fever  prevailed  in  only  one 
corner  of  it,  viz.,  in  Brownsville.  All  persons  were  detained  at 
least  ten  days  at  the  cordon  before  being  allowed  to  pass  north- 
ward,— a  period  of  probation  to  insure  that  no  one  having  the 
disease  should  carry  it  farther  north.  As  soon  as  practicable 
another  cordon  was  established  much  nearer  to  Brownsville, 
only  30  miles  from  it,  the  line  extending  from  the  mouth  of  the 
Sol  Colorado,  on  the  Gulf  of  Mexico,  to  Santa  Maria,  on  the 
Rio  Grande.  After  a  time  sufficient  to  prove  that  .no  more 
fever  prevailed  between  the  two  cordons,  the  first  one  was 
removed.  Within  the  second  line,  where  the  fever  prevailed, 
chiefly  in  Brownsville,  a  hospital  was  established  and  dispensa- 
ries opened  for  the  gratuitous  treatment  of  all  applicants. 

Upon  the  Mexican  side  of  the  Rio  Grande  the  fever  con- 
tinued to  spread  northwardly,  and,  in  order  to  oppose  it,  still 
another  cordon  had  to  be  established  on  the  American  side  of 
the  river,  extending  from  Santa  Maria  on  the  south  to  Laredo 
on  the  north,  a  distance  of  500  miles.  Three  hundred  guards 
well  mounted  (Texan  cow-boys)  were  employed  in  this  cordon, 
and,  while  the  disease  was  being  stamped  out  in  Brownsville, 
any  further  importation  from  Mexico  was  thus  prevented.  In 
Mexico  the  fever  continued  to  spread  until  the  authorities  finally 
adopted  measures  similar  to  the  above. 

Much  violent  language  has  been  used  concerning  the  hard- 
ships imposed  by  the  sanitary  cordon,  but  in  the  presence  of  an 
epidemic  the  authorities  who  are  responsible  need  to  pay  more 


396  TEXT-BOOK   OF   HYGIENE. 

heed  to  the  efficiency  of  the  cordon  than  to  individual  com- 
plaints. It  should  be  borne  in  mind  that  the  sanitary  cordon  is 
not  intended  to  bottle  up  all  the  people  who  are  caught  within 
an  infected  district.  On  the  contrary,  it  is  intended  as  a  means 
of  exit  to  those  who  will  not  carry  with  them  contagious  disease 
to  the  people  beyond. 

The  cordon,  then,  imposes  simply  a  period  of  detention 
corresponding  to  the  incubative  period  of  the  prevailing  disease. 
Ample  preparation  must  be  made  for  housing  and  feeding,  in 
camps  or  other  quarters,  persons  awaiting  the  expiration  of  the 
detention  period ;  and  hospitals  must  be  provided  for  the  treat- 
ment of  those  who  develop  sickness.  Provision  must  also  be 
made  for  the  disinfection  of  suspected  baggage. 

Camps  of  Probation. — Camps  of  probation  or  detention 
should  be  established  with  all  the  precision  of  arrangement 
and  regard  for  site,  water,  and  drainage  that  pertain  to  a  military 
camp.  Every  effort  should  be  made  to  make  the  camp  as  com- 
fortable and  cheerful  as  possible,  and  to  this  latter  end  amuse- 
ments and  entertainments  such  as  might  be  suggested  by  the 
campers  themselves  should  be  encouraged.  Every  necessity  in 
the  matter  of  food,  bedding,  and  the  ordinary  comforts  of  life 
should  be  anticipated  to  prevent  any  just  cause  of  complaint. 
Such  a  natural  division  of  the  inhabitants  should  be  made  as 
seems  desirable  at  the  time,  those  of  equal  intelligence  and 
refinement  naturally  seeking  each  other's  company.  The  greatest 
concern  is  to  prevent  the  camp  itself  from  becoming  infected. 
To  this  end  no  baggage  should  be  allowed  within  the  camp 
boundary  without  previous  disinfection ;  and  every  refugee 
should  be  examined  by  a  physician  before  being  admitted  to  the 
camp.  No  one  should  be  received  who  does  not  intend  to  pro- 
ceed to  an  uninfected  locality  after  his  probation.  In  other 
words,  a  camp  of  probation  should  not  be  used  as  one  of 
refuge. 

The  camp  must  be  surrounded  by  guards  to  prevent  egress 
or  ingress,  excepting  through  the  established  .portal.     At  least 


INLAND   QUARANTINE.  397 

twice  or  three  times  in  the  twenty-four  hours  all  refugees  should 
be  inspected  in  their  quarters,  and  any  case  of  sickness  at  once 
be  isolated  and  watched  until  the  diagnosis  is  certain.  If  the 
case  is  one  of  the  prevailing  disease,  the  patient  must  be  re- 
moved immediately  to  the  hospital,  which  should  be  at  a  safe 
distance,  half  a  mile  or  more,  from  the  camp.  Before  leaving 
the  camp,  each  refugee's  clothing  should  be  fumigated,  and  he 
should  be  given  a  certificate  that  he  has  passed  the  required 
period  of  probation.  A  clear  distinction  must  be  made  between 
camps  of  probation  and  camps  of  refuge.  Camps  of  refuge  are 
simply  residence  camps  established  to  receive  the  population  of 
an  infected  community  when  it  has  been  determined  to  depopu- 
late the  infected  district. 

Depopulation  of  a  house,  a  block,  a  district,  or  a  whole 
city,  if  possible,  the  people  moving  into  camps,  is  now  recog- 
nized as  a  valuable  means  of  controlling  an  epidemic ;  and 
there  may  be  either  camps  of  probation  or  simply  camps  of 
refuge,  or  both,  according  to  the  requirements  of  the  situation. 
Camps  of  refuge,  in  connection  with  depopulation,  were  sug- 
gested by  the  late  Surgeon-General  Wood  worth,  in  1878,  and 
the  measure  was  practically  carried  out  at  Memphis,  in  1879, 
by  the  establishment  of  Camp  Mitchell.  "  But  the  establish- 
ment of  a  camp  to  which  persons  from  infected  points  could  go, 
be  kept  under  observation  a  sufficient  length  of  time  to  demon- 
strate they  were  not  infected,  have  their  baggage  disinfected, 
and  be  given  '  free  pratique,'  is  apparently  a  new  departure  in 
inland  quarantine." 

Camp  Perry,  Fla. — Such  was  Camp  Perry,  Florida,  de- 
scribed by  the  surgeon  in  charge,  W.  H.  H.  Hutton,  in  the 
Marine-Hospital  Service  Report  for  1889.  The  site  was  admir- 
ably chosen  by  Passed- Assistant-Surgeon  John  Guiteras,  upon  a 
bluff  on  the  south  side  of  St.  Mary's  River,  the  dividing  line 
between  Florida  and  Georgia,  about  forty  miles  north  of  Jack- 
sonville, Fla.,  which  city  was  in  the  throes  of  a  yellow-fever 
epidemic.     The  camp  was  opened  August  20,  1888.     It  con- 


398  TEXT-BOOK   OF   HYGIENE. 

sisted,  in  its  completed  stage,  first,  of  50  wooden  cottages  built 
elsewhere  and  transported  on  cars.  Their  dimensions  were  12 
feet  by  10,  and  10  feet  in  height,  constructed  of  plain  lumber, 
with  cracks  battened,  and  windows  on  each  side  with  swinging 
shutters.  Each  held  four  cots,  chairs,  and  toilet-stand,  while 
unused  clothing  was  neatly  arranged  on  the  rafters  above. 
Besides  the  50  cottages  there  were  a  quartermaster  and  guard- 
house, commissary  building,  dining-room,  and  kitchen,  and 
laundry,  built  of  rough  lumber;  2  Ducker  portable  barracks, 
each  18  by  35  feet,  provided  with  12  beds  each,  and  350  tents, 
used  principally  by  the  single  men,  the  employes  and  guards, 
and  the  colored  refugees.  The  camp  was  laid  out  and  its 
military  discipline  established  under  the  temporary  personal 
command  of  Surgeon-General  Hamilton.  So  far  as  known  this 
is  the  first  camp  of  the  kind  ever  established,  at  least  in  the 
United  States.  The  cottages  were  arranged  in  a  quadrangle 
around  a  parade-ground  two  acres  in  extent,  and  the  tents  were 
arranged  in  streets  and  alleys  in  the  rear  of  the  cottages.  The 
accommodations  were  sufficient  for  600  people,  and  extra  tents 
were  on  hand  so  that  if  required  1000  persons  could  have  been 
provided  for,  or  3000  per  month,  allowing  for  only  ten  days' 
detention  of  each  person.  Two  hundred  hospital-tents  will 
accommodate  1200  people  comfortably,  according  to  Surgeon 
Hutton,  who  states  that  the  small  A-tents  are  unsuited  for 
women  and  children,  but  will  answer  for  men  or  boys.  Wire- 
mattress  cots  should  be  provided.  The  marine-hospital  officer 
at  Savannah,  Ga.,  was  the  purchasing  agent  for  the  camp,  and 
promptly  forwarded  all  subsistence  supplies  on  requisition  by 
mail  or  telegraph. 

Discipline  of  the  Gamp. — On  arrival  of  a  train,  each  pas- 
senger was  personally  examined  by  a  physician!,  his  health- 
certificate  scrutinized,  and  he  was  made  to  await  the  examination 
of  others.  Hand-bags,  clothing,  and  loose  wearing-apparel 
were  left  in  the  baggage-car  for  disinfection.  The  refugees  were 
then  marched  to  the  quartermaster's  room  for  registration  and 


INLAND    QUARANTINE. 


399 


assignment  to  quarters.  On  first  arrival  they  were  placed  in  the 
southern  part  of  the  camp,  and  in  two  days,  there  being  no 
sickness,  were  moved  forward  several  cabins,  and  this  progres- 
sion was  repeated  until  the  time  for  discharge. 

Twelve  guards  were  employed,  under  the  command  of  a 
captain,  and  were  divided  into  squads  of  four  each.  The 
schedule  was  so  arranged  that  each  guard  was  on  duty  two 
hours  and  off  duty  four. 


A  bugler  ai 

lllOU 

need 

the 

several  calls  as  follows: — 

5.30  a.m., 

.     Reveille. 

6.00  A.M.,      . 

Breakfast,  emploj'es. 

7.00  A.M.,      . 

Breakfast,  guests. 

9.00  A.M.,      . 

Surgeon's  call  and  inspection. 

12.00     m., 

Dinner,  employes. 

1.20  p.m., 

Dinner,  guests. 

4.30  p.m., 

Surgeon's  call  and  inspection. 

5.30  p.m., 

Supper,  guests. 

6.00  p.m., 

.     Sapper,  employes. 

6.30  p.m., 

.     Retreat  and  change  of  guard. 

9.00  p.m., 

.     Retiring  taps. 

The  yellow-fever  hospital-camp,  under  the  special  charge 
of  Dr.  Faget,  was  located  one-half  mile  from  the  probation 
camp.  It  consisted  of  2  frame  buildings,  2  hospital  and  12 
smaller  tents,  arranged  in  a  double-crescent  shape,  the  avenue 
in  the  middle  presenting  an  attractive  appearance. 

Of  the  12  small  tents,  4  were  for  nurses,  3  for  employes, 
2  for  convalescents,  and  1  each  for  drug-store,  storage-  and 
dead-  house.  One  of  the  hospital-tents  was  used  as  a  dining- 
room  for  employes,  convalescents,  and  parents  of  the  sick. 

The  hospital  was  established  September  3,  1888,  and  be- 
tween that  date  and  November  24th  35  cases  of  yellow  fever 
were  admitted  and  treated,  3  died,  and  32  were  discharged. 
Twelve  hundred  and  eleven  refugees  were  received  into  Camp 
Perry,  nearly  all  of  whom  were  from  the  infected  district  of 
Jacksonville. 

Thirty-five  cases  of  yellow  fever  were  caught  by  the  ten 


400  TEXT-BOOK    OF   HYGIENE. 

days'  detention,  but  no  case  of  fever  was  contracted  at  the  camp, 
and  of  the  1208  refugees  who  passed  the  required  detention  and 
proceeded  to  different  parts  of  the  country,  so  far  as  known,  not 
one  subsequently  developed  or  carried  the  disease  elsewhere. 
The  general  plan  of  the  preventive  measures  adopted  during  this 
epidemic  will  be  described  under  Railroad  Quarantine. 

Railroad  Quarantine,  Inspection  Service,  and  Disin- 
fection Stations. — Railroad  quarantine,  disinfection  stations, 
and  inspection  service  may  be  described  by  a  brief  account  of 
the  actual  measures  of  this  nature,  made  use  of  during  the 
yellow-fever  epidemic  in  Florida  in  1888,  of  which  Camp  Perry, 
just  described,  was  an  important  adjunct.  (For  details,  see 
annual  reports  marine-hospital  service,  1888  and  1889.) 

The  Governor  of  Florida  made  application  to  the  national 
authorities,  July  16th,  for  aid,  and  it  was  determined  to  prevent 
further  spread  of  the  disease  by  disinfecting  all  baggage  from 
infected  localities  before  permitting  its  transportation  into  other 
States,  and  by  enforcing  upon  all  persons  from  infected  localities 
seeking  to  leave  the  State  a  probationary  detention  of  ten  days. 

Accordingly,  disinfection-stations  were  established  at  two 
points,  through  which  all  persons  leaving  Florida  by  rail  were 
obliged  to  pass.  One  of  these  was  at  Live  Oak,  in  Northwestern 
Florida ;  the  other  at  Way  Cross,  Georgia,  near  the  boundary- 
line  of  Northeastern  Florida.  The  only  other  means  of  egress 
from  the  State  was  from  the  sea-ports;  but  healthy  sea-ports 
maintained  a  vigorous  quarantine  against  people  from  the  in- 
fected districts,  and  infected  sea-ports  were  not  visited  by  the 
steam-ship  lines,  because  their  vessels  would  thereby  be  made 
liable  to  quarantine  detention  at  other  ports.  The  fumigation 
of  baggage  at  Live  Oak  and  Way  Cross  was  accomplished  by 
means  of  box-cars  specially  prepared,  and  subsequently  in 
warehouses,  the  agent  being  sulphur  dioxide. 

Regarding  persons,  the  inspectors,  properly  uniformed  and 
wearing  official  shields,  boarded  the  trains  when  the  latter  arrived 
at  the  inspection-stations,  and  demanded  of  each  passenger  a 


INLAND   QUARANTINE.  401 

certificate,  showing  where  he  had  been  during  the  previous  ten 
days,  which  certificate  was  considered  valid  only  when  it  bore 
the  seal  or  signature  of  some  officer  of  health,  or  recognized 
municipal  authority.  The  inspectors  themselves  were  kept 
informed  regarding  all  infected  or  suspected  localities,  and  a 
person  coming  from  such  locality  was  either  made  to  return  to 
it,  or  given  the  option  of  going  to  the  camp  of  probation,  there 
to  spend  the  ten  days'  period  of  probation  before  being  allowed 
to  enter  other  States. 

This  was  Camp  Perry,  previously  described,  located  38 
miles  south  of  the  Way  Cross  Station,  and  40  miles  north  of 
Jacksonville,  where  the  epidemic  prevailed  chiefly.  All  egress 
from  Jacksonville  was,  perforce,  through  Camp  Perry  and  its  ten 
days'  probation. 

This  camp  was  a  means  of  protecting  not  only  other  States, 
but  the  uninfected  portions  of  Florida  itself,  more  particularly 
Southern  Florida,  whose  health  authorities  refused  to  admit 
within  their  limits  the  refugees  from  the  infected  districts  unless 
they  had  passed  the  period  of  probation  at  Camp  Perry.  To 
assist  in  this  protection  to  Southern  Florida,  no  person  was 
allowed  to  board  a  south-bound  train  between  Way  Cross, 
on  the  north,  and  Orange  Park,  a  station  20  miles  south  of 
Jacksonville. 

Moreover,  through  south-bound  trains  were  boarded  at 
Way  Cross,  and  all  passengers  compelled  to  furnish  evidence  of 
coming  from  healthful  localities.  The  evidence  consisted  of 
certificates  from  local  authorities,  baggage-checks,  or  railroad- 
tickets  showing  they  were  purchased  in  the  North,  and  in  some 
instances  letters  showing  by  the  superscription  and  stamps  where 
the  person  had  been. 

No  train,  excepting  the  special  government  train,  was 
allowed  to  stop  at  Camp  Perry.  A  government  train  also 
carried  those  who  had  passed  the  period  of  probation  from  Camp 
Perry  to  a  point  3  J  miles  distant,  Folkstone,  where  they  were 
transferred  to  a  regular  train  running  as  far  north  as  Way  Cross, 


26 


402  TEXT-BOOK    OF    HYGIENE. 

Ga.,  where  another  transfer  had  to  be  made  to  a  regular  north- 
bound train.  No  Florida  passenger-car  was  allowed  to  go  north, 
and  more  than  1000  baggage  and  freight  cars  were  disinfected 
by  government  officers  before  being  allowed  to  leave  the  State. 

The  methods  of  railroad  quarantine  may  also  be  studied 
in  a  review  of  the  action  taken  to  prevent  the  introduction  of 
small-pox  into  the  United  States  from  Canada,  where  it  prevailed 
extensively  in  the  fall  and  winter  of  1885,  and  January  and 
February,  1886. 

The  following  regulations  were  issued  by  the  Surgeon- 
General  of  the  Marine-Hospital  Service,  October,  10,  1885 : — 

The  act  approved  April  29,  1878,  entitled,  "  An  act  to  prevent  the 
introduction  of  contagious  or  infectious  diseases  into  the  United  States," 
provides  that  no  vessel  or  vehicle  coming  from  any  foreign  port  or 
country  where  an}r  contagious  or  infectious  disease  exists,  or  any  vessel 
or  vehicle  conveying  persons,  merchandise,  or  animals  affected  with  anjT 
contagious  disease,  shall  enter  any  port  of  the  United  States,  or  pass  the 
boundary-line  between  the  United  States  and  any  foreign  country,  except 
in  such  manner  as  may  be  prescribed  under  said  act. 

Attention  is  now  directed  to  the  prevalence  of  the  contagious  and 
infectious  disease  of  small-pox  in  Montreal  and  other  places  in  the 
Dominion  of  Canada,  and  the  law  referred  to  is  held  to  apply  alike  to 
trains  of  cars  and  other  vehicles  crossing  the  border,  and  to  vessels 
entering  ports  on  the  northern  frontier. 

Because,  therefore,  of  the  danger  which  attaches  to  the  transporta- 
tion of  persons  and  baggage,  and  articles  of  merchandise,  or  animals, 
from  the  infected  districts,  the  following  regulations  are  framed,  under 
the  direction  of  the  Secretary  of  the  Treasury,  and  subject  to  the 
approval  of  the  President,  for  the  protection  of  the  health  of  the  people 
of  the  United  States  against  the  danger  referred  to  : — 

1.  Until  further  orders  all  vessels  arriving  from  ports  in  Canada, 
and  trains  of  cars  and  other  vehicles  crossing  the  border-line,  must  be 
examined  by  a  medical  inspector  of  the  Marine-Hospital  Service  before 
they  will  be  allowed  to  enter  the  United  States,  unless  provision  shall 
have  been  made  by  State  or  municipal  quarantine  laws  and  regulations 
for  such  examination. 

2.  All  persons  arriving  from  Canada,  by  rail  or  otherwise,  must  be 
examined  by  such  medical  inspector  before  they  will  be  allowed  to  enter 
the  United  States,  unless  provision  has  been  made  for  such  examination. 


INLAND    QUARANTINE.  403 

3.  All  persons  coining  from  infected  districts,  not  giving  satis- 
factor}r  evidence  of  protection  against  small-pox,  will  be  prohibited  from 
proceeding  into  the  United  States  until  after  such  period  as  the  medical 
inspector,  the  local  quarantine,  or  other  sanitary  officer  duly  authorized, 
may  direct. 

4.  The  inspectors  will  vaccinate  all  unprotected  persons  who  desire, 
or  are  willing  to  submit  to,  vaccination  free  of  charge.  Any  such  person 
refusing  to  be  vaccinated  shall  be  prevented  from  entering  the  United 
States. 

5.  All  baggage,  clothing,  and  other  effects,  and  articles  of  mer- 
chandise, coming  from  infected  districts,  and  liable  to  carry  infection,  or 
suspected  of  being  infected,  will  be  subjected  to  thorough  disinfection. 

6.  All  persons  showing  evidence  of  having  had  small-pox  or  vario- 
loid, or  who  exhibit  a  well-defined  mark  of  recent  vaccination,  may  be 
considered  protected,  but  the  wearing-apparel  and  baggage  of  such  pro- 
tected persons  who  may  come  from  infected  districts,  or  have  been 
exposed  to  infection,  will  be  subjected  to  thorough  disinfection  as  above 
provided. 

7.  Customs  officers  and  United  States  medical  inspectors  will  con- 
sult and  act  in  conjunction  with  authorized  State  and  local  health  author- 
ities so  far  as  may  be  practicable,  and  unnecessary  detention  of  trains  or 
other  vehicles,  persons,  animals,  baggage,  or  merchandise,  will  be  avoided 
so  far  as  may  be  consistent  with  the  prevention  of  the  introduction  of 
diseases  dangerous  to  the  public  health  into  the  United  States. 

8.  Inspectors  will  make  full  weekly  reports  of  services  performed 
under  this  regulation. 

9.  As  provided  in  Section  5  of  said  act,  all  quarantine  officers  or 
agents  acting  under  any  State  or  municipal  sj^stem,  upon  the  application 
of  the  respective  State  or  municipal  authorities,  are  empowered  to  en- 
force the  provisions  of  these  regulations,  and  are  hereby  authorized  to 
prevent  the  entrance  into  the  United  States  of  any  vessel  or  vehicle, 
person,  merchandise,  or  animals  prohibited  under  the  act  aforesaid. 

10.  In  the  enforcement  of  these  regulations  there  shall  be  no  inter- 
ference  with  any  quarantine  laws  or  regulations  existing  under  or  to  be 
provided  for  by  any  State  or  municipal  authority. 

The  following  are  the  special  instructions  for  the  guidance 
of  sanitary  inspectors,  issued  by  Surgeon  H.  W.  Austin,  in 
charge  of  the  inspection  service  on  the  Canadian  frontier  from 
Buffalo,  N.  Y.,  to  the  Atlantic  coast  during  the  epidemic  above 
referred  to  (See  Marine-Hospital  Report,  1886): — 


404  TEXT-BOOK   OF   HYGIENE. 

Regulations  for  Sanitary  Inspectors. 

The  following  instructions  will  be  observed  by  the  sanitary  inspector 
on  the  following-mentioned  railroads  crossing  the  United  States  boundary- 
line,  viz.,  the  Grand  Trunk  Railway,  at  Rouse's  Point,  N.  Y.,  and 
Island  Pond,  Yt. ;  the  Passumpsic  Railroad,  at  Newport,  Yt. ;  the  Cen- 
tral Yermont  Railroad,  at  Highgate  Springs  or  Saint  Albans  ;  the  Canada 
Atlantic,  at  Rouse's  Point,  N.  Y. ;  and  the  Southeastern  Railway,  at 
Richford,  Yt.  :— 

All  persons  bound  for  the  United  States  coming  from  Montreal,  or 
other  places  in  Canada  where  small-pox  prevails,  must  produce  satisfac- 
tory evidence  to  the  inspector  that  they  are  protected  by  a  recent  vaccina- 
tion, or  submit  to  this  operation  before  they  are  allowed  to  cross  the 
boundary-line. 

Inspectors  will  vaccinate  all  unprotected  persons  free  of  charge. 

Persons  coming  from  Montreal,  or  suburban  villages,  will  be  care- 
fully questioned  as  to  their  residence,  whether  small-pox  has  occurred  in 
their  families,  or  whether  they  have  been  in  contact  with  the  disease. 

Inquiries  should  also  be  made  relative  to  their  baggage,  whether  it 
consists  of  bedding,  household  goods,  etc.,  likely  to  be  infected  ;  and  if 
any  person  or  article  of  baggage  is  considered  by  the  inspector  infected 
or  likely  to  introduce  the  disease  into  the  country,  he  or  it  should  not  be 
permitted  to  cross  the  line  into  the  United  States. 

You  maj'  consider  persons  protected  who  may  show  evidence  of 
having  had  the  small-pox  or  varioloid,  or  who  exhibit  a  well-defined  mark 
of  vaccination.  Accept  as  evidence  of  protection  a  certificate  from  any 
physician  in  good  standing  that  the  person  presenting  the  same  has  been 
successfully  vaccinated.  Should  you  doubt  the  validity  or  authenticity 
Of  the  certificate,  you  may  refuse  any  such  person  presenting  the  same 
the  privilege  of  crossing  the  border  unless  he  submits  to  vaccination. 
Baggage  known  to  have  come  from  any  infected  district,  and  believed  to 
be  infected,  will  be  thoroughly  fumigated  with  sulphur  at  Rouse's  Point, 
Saint  Albans,  Richford,  Newport,  and  Island  Pond. 

Weekly  reports  should  be  nwkde  to  Surgeon  H.  W.  Austin,  United 
States  Marine-Hospital  Service,  Burlington,  Yt.,  of  the  number  of  trains 
inspected,  number  of  persons  examined,  number  of  persons  vaccinated, 
number  of  pieces  of  baggage  fumigated,  and  any  other  information 
relative  to  services  performed  by  the  inspector. 

It  will  be  observed  that  all  the  railroads,  five  in  number, 
over  which  passengers  or  freight  might  be  brought  direct  from 
Canada  into  the  New  England  States  were  guarded. 


INLAND   QUARANTINE.  405 

Besides  the  line  commanded  by  Surgeon  Austin  (Atlantic 
coast  to  Buffalo),  another  line  was  under  the  direction  of  Passecl- 
Assistant-Surg-eon  Wheeler,  at  points  east  of  Buffalo,  and  still 
another  on  the  Michigan  frontier,  under  command  of  Surgeon 
W.  H.  Long.  These  lines  were  established  at  the  request  and 
with  the  co-operation  of  the  authorities  of  the  respective  States. 
Thirty-six  inspectors  were  employed  at  37  stations,  who  exam- 
ined 49,631  persons  on  railroad-trains,  vaccinated  16,547,  and 
detained  or  sent  back  603.  The  contents  of  more  than  7000 
pieces  of  baggage  were  disinfected.  The  measures  taken  were 
successful. 

The  following  are  the  rules  for  railroad  quarantine  adopted 
by  the  Quarantine  Conference  held  in  Montgomery,  Ala.,  March 
5th  to  7th,  1889:— 

1.  Quarantine  should  not  be  made  against  any  place  until  it  is 
official^  known  that  yellow  fever  or  other  infectious  or  contagious  dis- 
ease exists  at  such  place. 

2.  Only  competent  physicians  should  be  put  in  charge  of  quaran- 
tine stations,  and  only  thoroughly-qualified  persons  should  be  employed 
as  inspectors  on  railwa}^-trains. 

3.  Quarantine  stations  located  on  railroads  should  be  established 
at  convenient  points,  on  one  or  both  sides  of  a  town  or  station,  as  may 
be  deemed  necessary. 

4.  If  an  epidemic  of  yellow  fever  or  other  infectious  or  contagious 
disease  exist  at  a  town  or  station,  trains  carrying  passengers  or  freights 
should  be  required  to  pass  through  the  limits  of  such  towns  or  stations 
at  a  speed  of  not  less  than  ten  miles  per  hour,  without  stopping  at  such 
towns  or  stations,  but  should  stop  at  the  quarantine  station. 

5.  Passengers  to  or  from  such  infected  point  should  only  be  received 
or  delivered  at  the  quarantine  station,  under  the  supervision  of  the  quar- 
antine officer  in  charge  of  the  station. 

6.  Railway -tickets  may  be  sold  to  persons  leaving  an  infected  place 
to  any  point  willing  to  receive  them. 

T.  All  baggage  from  any  infected  point  should  be  properly  disin- 
fected. 

8.  As  far  as  practicable,  the  same  rules  proposed  for  railroads 
should  be  applied  to  vessels  of  every  kind,  stage-coaches,  or  other  means 
of  travel. 


406  TEXT-BOOK    OF   HYGIENE. 

9  The  passage  of  railroad-trains  through  any  point  on  the  line  of 
road,  whether  infected  or  not,  should  not  be  prohibited  by  any  quaran- 
tine regulations.  The  conductors  of  passenger-trains  should  close  the 
windows  and  ventilators  and  lock  the  doors  of  cars  passing  through  any 
place  where  a  train  is  not  permitted  to  stop. 

10.  All  freight  to  any  infected  place  should  be  delivered  either  at 
the  quarantine  station  or  the  nearest  railway-station  to  such  infected 
point  where  it  can  be  properly  cared  for. 

11.  All  mail-matter  from  any  infected  place  should  be  properly 
disinfected  by  the  United  States  Government ;  and  mail-matter  intended 
for  infected  points  should  be  put  off  the  trains  at  the  quarantine  stations. 
The  United  States  Government  should  instruct  postmasters  to  receive 
and  deliver  mails  at  such  quarantine  stations. 

12.  Railroads  and  express  companies  may  receive  for  transporta- 
tion from  any  infected  place,  during  the  time  such  infection  exists,  any 
merchandise  or  traffic  consigned  to  places  willing  to  receive  it. 

13.  State  authorities  should  employ  competent  persons  on  passen- 
ger-trains as  inspectors  of  passengers,  baggage,  and  express  matter,  as 
additional  precaution;  but  the  fact  of  inspectors  being  on  such  trains 
should  not  relieve  trains  carrying  passengers  or  express  matter  or 
baggage  from  stopping  at  quarantine  stations  for  such  inspection  as  the 
officer  in  charge  may  determine  to  be  necessary. 

14.  It  is  recommended  that  all  quarantines,  as  far  as  practicable, 
should  be  uniform  in  their  requirements  and  operations,  which  will 
greatly  contribute  to  the  prevention  of  panics,  and  tend  to  allay  un- 
necessary excitement  and  fear  on  the  part  of  the  people. 

15.  The  form  of  health  certificate  adopted  by  the  Quarantine  Con- 
vention, held  at  Montgomery,  March  5,  1889,  should  be  prepared  for 
health  officers  to  issue  to  such  persons  as  may  be  found  entitled  to  re- 
ceive the  same.  A  copy  of  this  certificate  should  be  printed  with  these 
rules,  and  conspicuously  posted  at  railway-stations. 

16.  It  is  the  desire  and  intention  of  health  authorities,  as  far  as 
practicable,  to  throw  every  safeguard  around  the  public  health  of  all 
localities.  Municipal,  county,  and  State  authorities  are  expected  to 
co-operate  in  every  possible  way  with  health  officers  located  in  towns, 
villages,  and  cities,  and  in  charge  of  quarantine  stations,  to  enable  them 
to  prevent  the  introduction  or  spread  of  3'ellow  fever  or  other  infectious 
or  contagious  diseases. 

It  was  also  resolved  by  this  conference  that  the  best  form 
of  disinfectant  for  personal  baggage  is  moist  heat. 


MUNICIPAL,    STATE,    AND    NATIONAL   QUARANTINE    LAWS.       407 

CORRELATION    OF    MUNICIPAL,    STATE,    AND    NATIONAL    QUARANTINE 

LAWS. 

As  shown  in  the  foregoing  pages,  quarantines  are  admin- 
istered under  three  forms  of  government, — local,  State,  and 
national.  A  vessel  arriving  at  a  given  port  may  be  refused 
permission  to  discharge  cargo  by  authority  of  either  a  national 
statute,  a  State  law,  or  a  city  ordinance.  At  Brooklyn,  for 
example,  if  the  United  States  officers  should  consent  to  a  vessel's 
entry  and  discharge,  restraint  could  still  be  imposed  by  the  State 
officers ;  and  if  the  latter  also  should  consent,  the  city  author- 
ities could  still  prevent.  In  some  instances,  as  at  Philadelphia 
and  New  Orleans,  municipal  officers  are  included  in  the  State 
quarantine  boards,  and  harmony  of  action  between  city  and 
State  is  thus  assured.  But,  unfortunately,  there  are  still  a  few 
States  which  exercise  either  little  or  no  supervision  of  quaran- 
tines, so  that  a  county  or  village  quarantine  may  be  purely  a 
local  affair  conducted  without  regard  to  neighboring  counties  or 
villages  or  to  the  rest  of  the  State.  It  is  this  form  of  quarantine 
which,  in  times  of  epidemic  and  panic,  has  for  so  many  years 
wrought  untold  misery,  which  has  given  rise  to  the  shot-gun 
quarantines,  checked  all  the  currents  of  trade  and  social  inter- 
course, arrayed  county  against  county,  village  against  village, 
and  turned  the  hand  of  neighbor  against  neighbor  in  a  ferocious 
struggle  to  ward  off  the  pestilence. 

Instances  of  this  form  of  quarantine  were  numerous  in  the 
Southern  States  during  the  yellow-fever  epidemic  of  1878,  when 
the  policy  of  non-intercourse  between  communities  was  so  rigidly 
enforced  that  many  were  cut  off  from  subsistence  supplies,  and 
there  was  danger  of  starvation. 

Much  has  been  written  upon  the  folly  of  the  shot-gun 
quarantines,  yet  communities  employing  this  method  have,  under 
their  peculiar  circumstances,  acted  wisely,  and  the  results,  as 
compared  with  those  of  similar  communities  neglecting  this 
method,  have  demonstrated  its  merit.  The  blame  for  all  the 
hardships  and  suffering  entailed  is  to  be  laid  upon  those  whose 


408  TEXT-BOOK   OF   HYGIENE. 

business  it  is  to  make  the  laws  of  the  State.  In  the  States  in- 
dicated there  were  no  State  boards  of  health,  or  they  were 
clothed  with  but  little  authority,  or,  being  formed  in  conjunction 
with  the  board  of  some  principal  sea-board  city,  gave  little  attend 
tion  to  inland  districts. 

The  most  recent  illustration  of  the  difficulties  made  by 
local  quarantines,  without  State  supervision,  was  in  Florida 
during  the  yellow-fever  epidemic  of  1888,  when  the  whole 
State,  there  being  no  central  sanitary  authority,  was  in  confusion 
through  the  enactments  of  village,  county,  and  city  boards  of 
health,  all  acting  independently,  with  no  common  plan  or  guid- 
ance. When  finally,  by  request  of  the  Governor,  the  United 
States  authorities  assumed  control,  the  petty  enactments  of  these 
small  local  boards,  and  their  adherence  to  their  rights,  gave 
great  trouble  to  the  government  officers,  some  of  whom  ex- 
perienced great  delay  and  personal  hardships  in  getting  through 
the  local  lines  to  the  points  of  danger  and  activity  to  which  they 
had  been  ordered.  This  epidemic  demonstrated  clearly  the  need 
of  a  State  board  of  health,  which  the  Legislature  has  since 
established.  State  boards  of  health  do  not  do  away  with  local 
boards,  but  make  them  work  in  harmony  on  broad  plans  laid 
down  in  the  interest  of  all. 

But  there  are  States  which  yet  have  no  boards  of  health, 
where,  in  case  of  epidemic,  the  old  confusion  might  arise  were 
it  not  for  a  new  exercise  of  power  on  the  part  of  the  national 
government,  made  possible  by  the  Act  of  Congress,  approved 
March  28,  1890,  known  as  the  Interstate  Quarantine  Act,  to 
which  further  reference  will  be  made. 

Having  shown  the  necessity  of  State  supervision  over 
village  and  county  quarantines,  it  is  now  pertinent  to  consider 
the  relation  of  the  States  to  one  another.  Theoretically,  in 
maritime  quarantine,  there  is  opportunity  for  clashing.  One 
State  might  be  very  rigid  in  its  exactions,  while  a  neighboring 
State,  owing  to  financial  stringency,  indifference,  or  a  desire  to 
divert  the  commerce  of  the  first  to  its  own  ports,  might  be  very 


MUNICIPAL,    STATE,    AND    NATIONAL    QUARANTINE    LAWS.       409 

lax.  On  this  account,  and  to  secure  uniformity  of  procedure, 
it  has  been  urged  that  all  maritime  quarantines  should  be  given 
over  to  the  national  government.  It  is  not  intended  to  enter 
into  this  subject  exhaustively,  but  it  may  be  remarked  that 
practically  there  is  little  clashing  between  the  State  maritime 
quarantines ;  and  that,  while  the  national  government  could 
readily  and  effectively  conduct  all  the  more  important  quaran- 
tines upon  the  coast,  to  establish  or  maintain  the  very  numerous 
smaller  ones  would  be  an  excess  of  responsibility  and  labor. 
Moreover,  it  would  seem  that  the  people  of  each  section  are 
best  qualified  to  judge  of  measures  of  protection  required  by 
their  own  peculiar  surroundings ;  and  if  they  were  not  it  might 
still  be  a  questionable  public  policy  to  relieve  the  State  govern- 
ments of  this  sanitary  responsibility,  and  encourage  thus  a  weak 
leaning  upon  the  national  government.  But  another  view  of 
the  matter  is  had  from  the  stand-point  of  the  interior  States. 
The  interior  States  are  as  much  interested  in  the  efficiency  of 
quarantine  at  New  York  or  New  Orleans  as  are  the  cities 
named,  for  fomites  failing  of  proper  disinfection  at  these  points 
are  rapidly  carried  to  innumerable  localities  in  the  interior. 
Thus,  in  a  measure,  the  people  of  the  whole  interior  are  de- 
pendent upon  these  quarantines,  that  is  to  say,  upon  the  legis- 
lative liberality  of  the  States  in  question,  and  the  efficiency  of 
their  executive  officers. 

Should,  however,  there  be  a  persistently  lax  maritime 
quarantine  on  the  part  of  a  State,  the  interior  States  could 
maintain  inland  quarantine  against  the  offending  one,  and  by 
thus  restricting  its  commerce  compel  a  greater  efficiency. 
Should  an  epidemic  disease  obtain  lodgment  in  a  State  the 
others  may,  and  frequently  do,  quarantine  against  it.  In  the 
Southern  States  particularly  the  interruption  to  interstate  com- 
merce has  been  frequent  by  reason  of  quarantines.  The  effect 
of  this  has  been  beneficial  in  that  it  has  stimulated  the  health 
authorities  in  their  efforts  to  exclude  epidemic  disease.  But  if 
there  is  danger  of  the  spread  of  cholera,  yellow  fever,  small- 


410  TEXT-BOOK   OF   HYGIENE. 

pox,  or  plague  from  one  State  to  another,  the  national  author- 
ities, by  virtue  of  the  interstate  quarantine  act,  may  adopt  the 
necessary  preventive  measures. 

The  relation  which  the  national  government  has  always 
borne  toward  the  States  in  the  matter  of  quarantine  is  that  of  a 
powerful  ally,  in  the  absence  of  local  quarantine  assuming 
jurisdiction,  giving  aid,  when  requested,  to  weak  quarantines, 
and  establishing  quarantines  at  points,  as  the  Delaware  Break- 
water and  Cape  Charles,  where  one  establishment  serves  for  the 
protection  of  several  States.  All  national  quarantines  have  been 
located  by  the  request  or  ready  assent  of  the  States  in  proximity. 

While  it  has  been  urged  that  quarantine  is  a  function  of 
the  general  government  by  reason  of  the  constitutional  right 
of  Congress  to  regulate  commerce,  the  other  theory  has  pre- 
vailed, viz.,  that  it  is  a  police  power  appertaining  to  the  State. 
The  first  quarantine  laws  were  enacted  by  the  States  or  colonies, 
by  Massachusetts,  for  example,  as  early  as  1648. 

A  resolution  looking  to  the  national  control  of  quarantine 
was  offered  in  the  Fourth  Congress,  April  28,  1796,  as  follows: 
"  Resolved,  That  the  President  of  the  United  States  be  authorized 
to  direct  such  quarantines  to  be  performed  on  all  vessels  from 
foreign  countries  arriving  at  the  ports  of  the  United  States  as 
he  shall  judge  necessary."  This  resolution  failed  to  pass,  but 
one  was  adopted  authorizing  the  President  "  to  direct  the  revenue 
officers  and  the  officers  commanding  ports  and  revenue-cutters 
to  aid  in  the  execution  of  quarantine  laws,  and  also  in  the 
execution  of  the  health  laws  of  the  States  respectively,  in  such 
manner  as  may  to  him  appear  necessary."  From  that  time 
until  the  passage  of  the  interstate  quarantine  act  of  1890,  there 
was  no  national  quarantine  legislation  that  was  not  distinctively 
and  only  in  aid  of  State  laws. 

With  regard  to  quarantine  fees,  however,  without  which 
many  State  and  local  quarantines  could  not  be  maintained,  it  is 
noticeable  that  Congress,  while  not  forbidding  their  exaction,  de- 
clares, in  Section  4792  of  the  Revised  Statutes,  that  "  nothing  in 


UNITED    STATES   QUARANTINE    LAWS   AND    REGULATIONS.       411 

this  Title  shall  enable  any  State  to  collect  a  duty  of  tonnage  or 
impost  without  the  consent  of  Congress."  The  inference  is 
that  Congress,  in  its  constitutional  power  to  regulate  commerce, 
is  unwilling  to  formally  surrender  this  right. 

The  right  of  the  State  to  impose  fees  has  been  affirmed, 
however,  by  the  Supreme  Court  of  the  United  States. 

Before  extending  quarantine  aid  to  a  State  it  is  the  custom 
of  the  government  to  obtain  a  formal  request  from  the  Governor 
or  State  sanitary  authorities.  The  agent  of  the  government  is 
the  Surgeon-General  of  the  Marine-Hospital  Service,  who 
assumes  then  the  direction  of  expenditures  and  measures. 
When  necessary  the  employes,  sanitary  guards,  etc.,  of  the 
Marine-Hospital  Service  are  given  a  proper  legal  footing  by 
being  sworn  in  as  State  or  local  officers,  deputy  sheriffs,  etc., 
and  likewise  under  the  law  State  officers  may  be  endowed  w7ith 
the  authority  of  United  States  sanitary  officers.  In  this  manner 
the  national  and  State  authorities  work  together  harmoniously. 
Following  are  the  United  States  quarantine  laws  in  full : — 

UNITED    STATES   QUARANTINE    LAWS   AND    REGULATIONS. 

Section  4792,  Revised  Statutes  of  the  United  States. 
The  quarantines  and  other  restraints  established  by  the  health  laws 
of  any  State,  respecting  any  vessels  arriving  in,  or  bound  to,  any  port  or 
district  thereof,  shall  be  duly  observed  by  the  officers  of  the  customs 
revenue  of  the  United  States,  by  the  masters  and  crews  of  the  several 
revenue-cutters,  and  by  the  military  officers  commanding  in  any  fort  or 
station  upon  the  sea-coast ;  and  all  such  officers  of  the  United  States 
shall  faithfully  aid  in  the  execution  of  such  quarantines  and  health  laws, 
according  to  their  respective  powers  and  within  their  respective  precincts, 
and  as  they  shall  be  directed,  from  time  to  time,  by  the  Secretary  of  the 
Treasury.  But  nothing  in  this  Title  shall  enable  an}1-  State  to  collect  a 
duty  of  tonnage  or  impost  without  the  consent  of  Congress. 

NATIONAL   QUARANTINE   ACT. 

AN  ACT  to  prevent  the  introduction  of  contagious  or  infectious  diseases  into  the 

United  States. 
Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
United  States  of  America,  in   Congress  assembled,  That  no  vessel  or 
vehicle  coming  from  any  foreign  port  or  country  where  any  contagious 


412  TEXT-BOOK   OF   HYGIENE. 

or  infectious  disease  may  exist,  and  no  vessel  or  vehicle  conveying  any 
person  or  persons,  merchandise,  or  animals  infected  with  any  infectious 
or  contagious  disease,  shall  enter  any  port  of  the  United  States,  or  pass 
the  boundary-line  between  the  United  States  and  any  foreign  country, 
contrary  to  the  quarantine  laws  of  any  one  of  said  United  States,  into 
or  through  the  jurisdiction  of  which  said  vessel  or  vehicle  may  pass,  or 
to  which  it  is  destined,  or  except  in  the  manner  and  subject  to  the  regula- 
tions to  be  prescribed,  as  hereinafter  provided. 

Sec.  2.  That  whenever  any  infectious  or  contagious  disease  shall 
appear  in  any  foreign  port  or  country,  and  whenever  any  vessel  shall 
leave  any  infected  foreign  port,  or,  having  on  board  goods  or  passengers 
coming  from  any  place  or  district  infected  with  cholera  or  yellow  fever, 
shall  leave  any  foreign  port,  bound  for  any  port  in  the  United  States,  the 
consular  officer,  or  other  representative  of  the  United  States  at  or  nearest 
such  foreign  port  shall  immediately  give  information  thereof  to  the 
Supervising  Surgeon-General  of  the  Marine-Hospital  Service,  and  shall 
report  to  him  the  name,  the  date  of  departure,  and  the  port  of  destination 
of  such  vessel ;  and  shall  also  make  the  same  report  to  the  health  officer 
of  the  port  of  destination  in  the  United  States,  and  the  consular  officers 
of  the  United  States  shall  make  weekly  reports  to  him  of  the  sanitary 
condition  of  the  ports  at  which  they  are  respectively  stationed  ;  and  the 
said  Surgeon-General  of  the  Marine-Hospital  Service  shall,  under  the 
direction  of  the  Secretary  of  the  Treasury,  be  charged  with  the  execu- 
tion of  the  provisions  of  this  act,  and  shall  frame  all  needful  rules  and 
regulations  for  that  purpose,  which  rules  and  regulations  shall  be  subject 
to  the  approval  of  the  President,  but  such  rules  and  regulations  shall  not 
conflict  with  or  impair  any  sanitary  or  quarantine  laws  or  regulations  of 
any  State  or  municipal  authorities  now  existing,  or  which  may  hereafter 
be  enacted. 

Sec.  3.  That  it  shall  be  the  duty  of  the  medical  officers  of  the 
Marine-Hospital  Service  and  of  customs  officers  to  aid  in  the  enforce- 
ment of  the  national  quarantine  rides  and  regulations  established  under 
the  preceding  section ;  but  no  additional  compensation  shall  be  allowed 
said  officers  by  reason  of  such  services  as  they  may  be  required  to  per- 
form under  this  act,  except  actual  and  necessary  traveling  expenses. 

Sec.  4.  That  the  Surgeon-General  of  the  Marine-Hospital  Service 
shall,  upon  receipt  of  information  of  the  departure  of  any  vessel,  goods, 
or  passengers  from  infected  places  to  any  port  in  the  United  States, 
immediately  notify  the  proper  State  or  municipal  and  United  States 
officer  or  officers  at  the  threatened  port  of  destination  of  the  vessel,  and 
shall  prepare  and  transmit  to  the  medical  officers  of  the  Marine-Hospital 
Service,  to  collectors  of  customs,  and  to  the  State  and  municipal  health 


UNITED    STATES   QUARANTINE    LAWS   AND    REGULATIONS.       413 

authorities  of  the  United  States  weekty  abstracts  of  the  consular  sani- 
tary reports  and  other  pertinent  information  received  by  him. 

Sec.  5.  That  whenever,  at  any  port  of  the  United  States,  any  State 
or  municipal  quarantine  system  may  now  or  may  hereafter  exist,  the  offi- 
cers or  agents  of  such  system  shall,  upon  the  application  of  the  respective 
State  or  municipal  authorities,  be  authorized  and  empowered  to  act  as 
officers  or  agents  of  the  national  quarantine  sj^stem,  and  shall  be  clothed 
with  all  the  powers  of  United  States  officers  for  quarantine  purposes, 
but  shall  receive  no  pay  or  emolument  from  the  United  States.  At  all 
other  ports  where,  in  the  opinion  of  the  Secretary  of  the  Treasury,  it 
shall  be  deemed  necessary  to  establish  quarantine,  the  medical  officers  or 
other  agents  of  the  Marine-Hospital  Service  shall  perform  such  duties  in 
the  enforcement  of  the  quarantine  rules  and  regulations  as  may  be 
assigned  them  by  the  Surgeon-General  of  that  Service  under  this  act : 
Provided,  That  there  shall  be  no  interference  in  any  manner  with  any 
quarantine  laws  or  regulations  as  they  now  exist,  or  may  hereafter  be 
adopted  under  State  laws. 

Sec.  6.  That  all  acts  or  parts  of  acts  inconsistent  with  this  act  be, 
and  the  same  are  hereby,  repealed. 

Approved  April  29,  1878. 

[Extract  from  Quarantine  Act  of  August  1, 1888.] 
AN  ACT  to  perfect  the  quarantine  service  of  the  United  States. 

Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
United  States  of  America,  in  Congress  assembled,  That  whenever  any 
person  shall  trespass  upon  the  grounds  belonging  to  any  quarantine 
reservation,  or  whenever  any  person,  master,  pilot,  or  owner  of  a  vessel 
entering  any  port  of  the  United  States,  shall  so  enter  in  violation  of 
Section  1  of  the  act  entitled,  "An  act  to  prevent  the  introduction  of 
contagious  or  infectious  diseases  into  the  United  States,"  approved  April 
twenty -ninth,  eighteen  hundred  and  seventy-eight,  or  in  violation  of  the 
quarantine  regulations  framed  under  said  act,  such  person,  trespassing, 
or  such  master,  pilot,  or  other  person  in  command  of  a  vessel  shall,  upon 
conviction  thereof,  pay  a  fine  of  not  more  than  three  hundred  dollars,  or 
be  sentenced  to  imprisonment  for  a  period  of  not  more  than  thirty  days, 
or  shall  be  punished  by  both  fine  and  imprisonment,  at  the  discretion  of 
the  court.  And  it  shall  be  the  duty  of  the  United  States  attorney  in 
the  district  where  the  misdemeanor  shall  have  been  committed  to  take 
immediate  cognizance  of  the  offense,  upon  report  made  to  him  by  any 
medical  officer  of  the  Marine-Hospital  Service,  or  by  any  officer  of  the 
Customs  Service,  or  by  any  State  officer  acting  under  authority  of 
Section  5  of  said  act- 


414  TEXT-BOOK   OF   HYGIENE. 

Sec.  2.  That  as  soon  after  the  passage  of  this  act  as  practicable,  the 
Secretary  of  the  Treasury  shall  cause  to  be  established,  in  addition  to 
the  quarantine  established  by  the  act  approved  March  fifth,  eighteen 
hundred  and  eightj^-eight,  quarantine  stations,  as  follows  :  One  at  the 
mouth  of  the  Delaware  Bay ;  one  near  Cape  Charles,  at  the  entrance  of 
the  Chesapeake  Bay;  one  on  the  Georgia  coast;  one  at  or  near  Key 
West ;  one  in  San  Diego  Harbor  ;  one  in  San  Francisco  Harbor  ;  and  one 
at  or  near  Port  Townsend,  at  the  entrance  to  Puget  Sound  ;  and  the  said 
quarantine  stations  when  so  established  shall  be  conducted  by  the 
Marine-Hospital  Service  under  regulations  framed  in  accordance  with  the 

act  of  April  twenty-ninth,  eighteen  hundred  and  seventy-eight. 

************ 

Approved  August  1,  1888. 

AN  ACT  to  prevent  the  introduction  of  contagious  diseases  from  one  State  to  another  and 
for  the  punishment  of  certain  offenses. 

Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the  United 
States  of  America  in  Congress  assembled,  That  whenever  it  shall  be  made 
to  appear  to  the  satisfaction  of  the  President  that  cholera,  yellow  fever, 
small-pox,  or  plague  exists  in  any  State  or  Territory,  or  in  the  District 
of  Columbia,  and  that  there  is  danger  of  the  spread  of  such  disease  into 
other  States,  Territories,  or  the  District  of  Columbia,  he  is  hereby  author- 
ized to  cause  the  Secretary  of  the  Treasury  to  promulgate  such  rules 
and  regulations  as  in  his  judgment  may  be  necessary  to  prevent  the 
spread  of  such  disease  from  one  State  or  Territory  into  another,  or  from 
any  State  or  Territory  into  the  District  of  Columbia,  or  from  the  District 
of  Columbia  into  an}r  State  or  Territory,  and  to  employ  such  inspectors 
and  other  persons  as  may  be  necessary  to  execute  such  regulations  to 
prevent  the  spread  of  such  disease.  The  said  rules  and  regulations  shall 
be  prepared  by  the  Supervising  Surgeon-General  of  the  Marine-Hospital 
Service,  under  the  direction  of  the  Secretary  of  the  Treasury.  And  any 
person  who  shall  willfully  violate  any  rule  or  regulation  so  made  and 
promulgated  shall  be  deemed  guilty  of  a  misdemeanor,  and  upon  convic- 
tion shall  be  punished  by  a  fine  of  not  more  than  five  hundred  dollars, 
or  imprisonment  for  not  more  than  two  years,  or  both,  in  the  discretion 
of  the  court. 

Sec  2.  That  any  officer,  or  person  acting  as  an  officer,  or  agent  of 
the  United  States  at  any  quarantine  station,  or  other  person  employed  to 
aid  in  preventing  the  spread  of  such  disease,  who  shall  willfully  violate 
any  of  the  quarantine  laws  of  the  United  States,  or  any  of  the  rules  and 
regulations  made  and  promulgated  by  the  Secretary  of  the  Treasury  as 
provided  for  in  Section  1  of  this  act,  or  any  lawful  order  of  his  superior 


UNITED    STATES   QUARANTINE    LAWS    AND    REGULATIONS.       415 

officer  or  officers,  shall  be  deemed  guilty  of  a  misdemeanor,  and  upon 
conviction  shall  be  punished  by  a  fine  of  not  more  than  three  hundred 
dollars,  or  imprisonment  for  not  more  than  one  year,  or  both,  in  the  dis- 
cretion of  the  court. 

Sec.  3.  That  when  any  common  carrier  or  officer,  agent,  or  employe 
of  any  common  carrier  shall  willfully  violate  any  of  the  quarantine  laws 
of  the  United  States,  or  the  rules  and  regulations  made  and  promulgated 
as  provided  for  in  Section  1  of  this  act,  such  common  carrier,  officer, 
agent,  or  employe  shall  be  deemed  guilty  of  a  misdemeanor,  and  shall, 
upon  conviction,  be  punished  by  a  fine  of  not  more  than  five  hundred 
dollars,  or  imprisonment  for  not  more  than  two  years,  or  both,  in  the  dis- 
cretion of  the  court. 

Approved  March  28,  1890. 


INDEX. 


Absolute  and  relative  humidity,  6 
Actinomycosis,  343 
Adjustable  scbool-desk,  197 
Adulterations  in  milk,  91 

of  flour,  107 
"A.  G.  M."  water-closet,  170 
Aids  to  quarantine,  392 
Air-currents  and  their  influence  upon 

.    health,  18 
Alcohol  poisoning,  112 
Alcoholic  beverages,  111 
Alkaloidal  beverages,  117 
Alum  as  a  purifier  of  muddy  water,  59 
Ammonia  in  water,  74 
Angus  Smith's  experiments  on  carbon 

dioxide  and  organic  matter,  27 
Aniline  poisoning,  220 
Animal  diseases  and  ground-water,  133 
Anthrax,  345 

Antiseptics  and  antisepsis,  347 
Arsenic  in  wall-papers,  163 

poisoning,  225 
Atmosphere,  composition  and  physical 
conditions  of,  2 

its  influence  upon  health,  1 

its  limit  upward,  3 
Atmospheric  pressure  and  health,  8 

Bacillus  anthracis  as  a  cause  of  diseased 

meat,  103 
Bacillus  of  anthrax,  345 

of  glanders,  345 

of  typhoid  fever,  329 
Bacteria  in  the  atmosphere,  32 
Bacteriological  examination  of  drinking- 
water,  77 
Baker,  H.  B.,  on  effects  of  low  tempera- 
ture on  health,  15 
Barometric  pressure,  3 
Barracks,  234 
Bathing,  dangers  of,  270 

rules  for,  269 
Baths  and  bathing,  267 
Beer,  116 

Berber's  system,  144 
Bert's   observations  on  diminished  at- 
mospheric pressure,  10 
Birth-rates,  363 
Black  death,  294 

hole  of  Calcutta,  28 


Boccaccio  on  the  plague,  294 

Bora,  19 

Boudin  on  malarial  fever  from  drinking- 
water,  60 

Bovine  tuberculosis,  344 

Bowditch,  H.  L,  on  soil  moisture  and 
consumption,  131 

Brandy,  114 

"Brass-founders'  ague,"  219 

Bread,  106 

Broad  Street  pump  epidemic  of  cholera, 
64 

Buchanan,  Dr.  G.,  on  earth-closets,  142 
on  soil  moisture  and  consumption, 
132 

Burial-grounds,  supposed  dangers  of, 
280 

Bury  ventilator,  161 

Butter,  95 

Cabiadis  on  the  plague  in  Bagdad,  297 
Cable,  G.  W.,  on  convict-lease  system, 

257 
Caisson  disease,  12 
Camp  diseases,  236 

Perry,  397 
Camps  of  probation,  396 
Carbon-bisulphide  poisoning,  215 
Carbon  dioxide  in  atmosphere,  2,  26 

poisoning,  214 
Carbon  monoxide  in  air,  29  # 

poisoning,  213 
Caterham  epidemic  of  typhoid  fever,  61 
Cerebro-spinal  meningitis,  339 
Chamberland's  filter,  69 
Chambers,  J.   W.,  on  pollution  of  hy- 
drant-water, 66 
Chantemesse  and  Vidal  on  the  bacillus 
typhoideus  in  drinking-water,  63 
Cheese,  96 

Chemical  composition  of  ground-air,  123 
Chlorides  in  water,  72 
Chlorine-gas  poisoning,  212 
Chocolate,  118 
"Choke-damp,"  214 
Cholera  and  drinking-water,  321 

and  ground-water,  130 

Asiatica,  314 

bacillus,  319 

causation  of,  320 


27 


(417) 


418 


INDEX. 


Cholera  from  infected  water,  64 

prevention  of,  323 

special  quarantine  measures  against, 
389 
Cider,  115 

Cisterns  as  storage  reservoirs,  47 
Civilian  camps,  240 
Classification  of  drinking-waters,  78 
Clothing,  absorption  of  heat  by,  275 

how  to  render  non-inflammable,  278 

materials,  275 

of  the  soldier,  233 
Coal-gas,  30 
Coffee,  117 
Condiments,  108 
Connolly  trap,  176 

Consumption    among    school-children, 
204 

and  soil  moisture,  131 
Contagion  and  infection,  289 
Contagious  diseases  and  schools,  204 
Contagium  animatum,  285 
Contamination  of  hydrant-water,  66 
Cowles,  Dr.  E.,  experiments  on  heating 

hospitals,  184 
Creamometer,  94 
Cremation,  282 

of  sewage  and  garbage,  150 
Cucumber  odor  in  drinking-water,  52 
Cultivation  of  bacteria,  288 
Cysticercus  in  meat,  100 

Da  Costa,  Dr.  J.  M.,  on  irritable  heart, 

264 
Daily  allowance  of  water  in  American 

cities,  46 
Dead,  disposal  of,  279 
Death-rate  and  birth-rate,  361 
Decayed  meat  and  fish  as  causes  of  dis- 
ease, 100 
i'  Dececo"  closet,  171 
DeChaumont's  rale  regarding  ground- 
water oscillations,  130 
Defective   hearing  among    school-chil- 
dren, 202 
Defoe,  on  the  plague,  295 
Dengue,  336 
Deodorizers,  348 

Diarrhoea  and  dysentery  in  armies,  236 
Dickson,  on  the  plague  in  India,  297 
Digestive  derangements  among  school- 
children, 203 
Diphtheria,  335 

Diseases  caused  by  high  temperature,  14 
from  impure  water,  58 
from  infected  and  spoiled  meat,  99 
from  infected  milk,  92 
from  soil  impurities,  129 
on  shipboard,  252 
Disinfectants  and  disinfection,  347 
Disinfection,  methods  of,  353 


Distilled  water,  54 
Drainage  of  wet  soils,  133 
Drowned  persons,  restoration  of,  270 
Duration  of  infection,  291 
Dwellings  and  overcrowding,  151 

materials  of  which  to  be  built,  158 

Earth-closets,  141 

Eberth's  bacillus  as  a  cause  of  typhoid 
fever,  63 

Eggs  as  food,  105 

Electric  light  and  its  dangers,  165 

Emmerich  on  the  innocuousness  of  im- 
pure water,  61 

Entombment,  281 

Epidemic  diseases,  290 

due  to  defective  ventilation,  29 

Erismann  on  Liernur's  system,  143 

Exercise  and  training,  261 

physiological  effects  of,  261 

Filtration  of  water,  69 

"Fire-damp,"  30,  214 

Flushing  cistern  for  water-closets,  173 

Fodor,  on  the  production  of  carbon  di- 
oxide, 27 

Fohn,  19 

Folsom,  C.  F.,  on  typhoid  fever  from 
infected  water,  63 

Food  necessary  to  health,  81 
of  the  soldier,  232 

Forwood,  Dr.  W.  S.,  on  hydrochloric- 
acid  fumes,  212 

Freire,  on  yellow-fever  germ  in  soil,  125 

Fresh-air  inlet,  177 

Gardner,  James  T.,  on  Rochdale  sys- 
tem, 139 
Gas  poisoning,  29 
Germ  theory,  285 
Gihon,  Dr.  A.  L  ,  on  naval  hygiene,  243 

on  syphilis  in  the  United  States,  342 
Gin,  115 
Glanders,  345 
Green  vegetables,  108 
Ground-air,  122 
Ground-water,  127 

and  cholera,  130 

and  typhoid  fever,  131 

Habitations,  151 

Hammond's  experiment  on  organic  mat- 
ter in  the  air,  28 

Hardness  of  water,  56 

Harmattan,  19 

Heart  disease  and  altitude,  11 

Heating  and  ventilation  of  dwellings, 
160 

Hecker  on  the  plague,  294 

Holt,  Dr.  Jos.,  on  Louisiana  quarantine, 
374 


INDEX. 


419 


Hopper-closets,  169 

Hospital    administration  and  manage- 
ment, 187 
records,  189 

Hospitals,  179 

House-drainage,  166 

Howard,  John,  on  hospital  construction, 
183 

Humidity  and  health,  18 
of  the  atmosphere,  5 

Hydrophobia,  344 

Illuminating  gas,  dangers  of,  164 
Impurities  in  water,  55 
Increased  atmospheric  pressure,  12 
Incubation  of  infectious  diseases,  table 

of,  291 
Industrial  hygiene,  207 
Influence  of  barometric  pressure  upon 

results  of  operations,  12 
Influenza,  338 
Inland  quarantine,  393 
Inoculation  of  small-pox,  303 
Interment,  279 
in  war,  282 
Iodine  poisoning,  216 

Jenner,  Edward,  and  vaccination,  306 
Jesty,  Benjamin,  306 
Johns  Hopkins  Hospital,  180 
Jones,  Dr.  Joseph,  on  syphilis  among 
the  mound-builders,  341 

Kefyr,  116 

Kober,  G.  M.,  on  mountain  fever,  49 

Koch,  R.,  on  the  cholera  spirillum  in 

drinking-water,  65 
Kumys,  116 

Lakes  and  ponds  as  sources  of  drinking- 
water,  51 

Lambrecht's  polymeter,  8 

Lead  poisoning,  217 

Legumes,  107 

Liernur's  pneumatic  system,  143 

Lighting  of  dwellings,  163 

Lortet's  observations  on  diminished  at- 
mospheric pressure,  8 

Louisiana  quarantine,  371 

Low  temperature  as  a  cause  of  respira- 
tory diseases,  15 

Malarial  fevers  in  armies,  237 
Marine  hygiene,  243 
Maritime  quarantine,  367 
administration  of,  380 
Marsh-water  and  malaria,  59 
Marshall,  John,  on  cholera  from  infected 

water,  64 
Maryland  Maternite  case-record,  189 
Mate,  119 


McClellan's  trap,  174 
McSherry,  R.,  on  siguatera,  102 
Measles,  334 
Meat,  97 

extracts  and  essences,  99 
Mercurial  poisoning,  218 
Metabolism  during  muscular  exercise,  88 
Methods  of  cooking,  109 

of  sewage  removal,  136 
Michigan  method  of  restoring  the  appa- 
rently drowned,  271 
Midden  privies,  138 
Military  and  camp  hygiene,  231 
Milk  as  food,  89 

sickness,  94 
Mineral  poisons  in  water,  75 
Mistral,  18 
Montague,  Lady  M.  W.,  on  inoculation, 

303 
Montgomery  quarantine  conference,  405 
Moore,  J.  W.,  on  seasonal  prevalence 

of  pneumonia,  17 
Morin,  on  fresh  air  required  in  occupied 

apartments,  40 
Mortality  in  prisons,  257 
Motion  of  the  atmosphere,  7 
Mountain  fever,  49 

sickness,  10 
Myopia  of  school-children,  199 

National  quarantines,  368 
Blackbeard  Island,  387 
Chandeleur  Island,  385 
Delaware  Breakwater,  388 
stations,  regulations  for,  380 

Naval  hygiene,  243 
rations,  251 

Neirnsee,  J.  R  ,  on  ventilating  hospital 
wards,  184 

Nervous  disorders  among  school-chil- 
dren, 203 

New  York  quarantine,  370 

Nichols,  A.  H.,  on  pollution  of  drinking 
water,  52 

Nitrates  and  nitrites  in  water,  73 

Norther,  19 

Occupation  neuroses,  229 
Occupations,  hygiene  of,  207 
Organic  matter  in  water,  71 
Organisms  in  small -pox,  302 
Oriental  plague,  293 
Over    Darwen    epidemic    of  drinking- 
water,  62 
Overexertion,  264 

Oxygen  and  C02  in  ground -air,  124 
Oxygen  in  atmospheric  air,  3 
Ozone  in  the  atmosphere,  7 

Pan-closets,  167 

Passengers  on  shipboard,  246 


420 


INDEX. 


Pathogenic  organisms  in  ground-air,  124 
Pavilion  hospitals,  18 
Pebrine,  286 

Pengra,  C.  P.,  on  bacteria  in  drinking- 
water,  53 
Pensacola  quarantine  regulations,  883 
Pepper,  William,  on  consumption  and 

soil  moisture,  132 
Perlsucht.  344 

Peroxide   of   hydrogen    in  the   atmos- 
phere, 7 
Petroleum  vapor  as  a  poison,  217 
Pettenkofer,  on  ground- air,  123 

on  ground-water  and  cholera,  322 
Phosphorus  necrosis,  226 
Phthisis  in  armies,  238 
Physical  training,  262 
Physiological  action  of  alcohol,  111 
Plague,  293 
Plunger-closets,  168 

Plymouth  epidemic  of  typhoid  fever,  63 
Pneumonia  and  cold  weather,  16 
Poisonous  dust,  221 

gases  and  vapors,  211 
Power,  W.  H.,  on   scarlet  fever  from 

milk,  93 
Preventive  inoculation,  287 
Prison  hygiene,  255 

punishments,  258 
Privies,  deodorization   of    contents   of, 
137 

removal  of  contents  of,  137 

ventilation  of,  187 
Privy-vaults,  construction  of,  136 
-    pits,  138 

system,  136 

wells,  138 
Procopius,  on  the  plague,  293 
Prudden,  on  typhoid  bacilli  in  drinking- 
water,  53 
Ptomaines  in  meat,  101 
Public  baths,  273 
Purification  of  drinking-water,  68 
Purulent  conjunctivitis,  238 

Quarantinable  diseases,  366 
Quarantine,  365 

aids,  392 

conference  at  Montgomery,  405 

contrivances,  377 

correlation  of  national,   State,  and 
municipal  laws,  407 

laws  of  United  States,  411 

practice,  384 

regulations,  Pensacola,  383 
Texas,  382 

Rabies,  344 

Rag-sorters'  disease,  224 
Railroad  inspection   against  small-pox, 
404 


Railroad     inspection     against     yellow 
fever,  402 

quarantine,  400 
Registration  of  births,  360 

of  deaths,  359 

of  diseases,  361 

of  marriages,  360 
Relapsing  fever,  327 
Rennie,  on  the  plague,  297 
Restoration  of  apparently  drowned  per- 
sons, 270 
River- water,  48 
Rochdale  system,  139 
Roy,   A.,  on  carbon-dioxide  poisoning, 

214 
Rum,  115 

Sailor-life,  243 

Salomon,  Dr.  L.  F.,  on  sulphur  disin- 
fection, 879 
Sanitary  cordon,  393 
Sausage  poisoning,  101 
Scarlet  fever,  834 

from  milk,  93 
Schlagintweit's  observations  on  moun- 
tain sickness,  9 
Schone  system,  144 
School  furniture,  196 

house  construction,  193 

life,  diseases  of,  199 
Scurvy  in  armies,  238 
Sea-bathing,  268 

Season  and  mortality  from  various  dis- 
eases, 20 
Seaton  and  Buchanan,    on    protective 

power  of  vaccination,  309 
Self-purification  of  flowing  water,  50 
Separate  system,  144 
Sewage  and  sewerage,  135 

farms,  149 

final  disposal  of,  149 

irrigation  at  Pullman,  149 
Sewer-air,  30 
Sheep-pock,  343 
Ship  sanitation,  246 
Simoon,  19 
Sirocco,  19 

Site  for  dwellings,  153 
Small-pox,  299 
Smart,  C,  on  mountain  fever,  49 

on  pollution  of  cistern-water,  47 
Soap  test  for  hardness  in  water,  56 
Soil  atmosphere,  122 
Soil,  character  of,  for  building-sites,  154 

its  physical   and  chemical  charac- 
ters, 121 

moisture  and  health,  153 

pipe,  175 
Sources  of  drinking-water,  47 
Spinal  curvature  in  school-children,  202 
Spirillum  of  relapsing  fever,  328 


INDEX. 


421 


Splenic  fever,  288 

Spongilla  fluviatilis,  52 

Spring-water,  53 

Standards  of  purity  of  drinking-water, 

55 
Steam  disinfecting-chamber,  379 
Sternberg,    G.    M.,    on    destruction    of 

pathogenic     germs     by     boiling 

water,  68 
on   yellow-fever  germs  of  Freire, 

125 
Storage  of  water,  47 
Study  hours  for  pupils,  198 
Suicide  and  season,  26 
Sun-stroke  and  humidity,  13 
Supervision  of  sanitary  arrangements, 

177 
Sweating  sickness,  298 
Swell-head,  343 
Swill-milk,  93 
Syphilis,  340 

Table  of  constituents  of  animal  foods, 
84 

of  constituents  of  vegetable  foods, 
85 
Tea,  118 
Temperature  and  health,  13 

of  the  air,  5 

of  fire-rooms  of  ships,  250 
Tents  and  huts,  235 
Tests  for  atmospheric  impurities,  33 

for  impurities  in  drinking-water,  70 
Texas  quarantine  regulations,  382 
Thorne  on  typhoid  fever  from  drinking- 
water,  61 
Tobacco,  119 

Toilet's  system  of  barracks,  234 
Total  solids  in  water,  71 
Tracy,   Dr.    R.    S.,  on   infecundity  of 

tobacco-workers,  223 
Traps,  173 

Trichina  spiralis  in  meat,  99 
Tuberculous  meat,  104 
Typhoid  fever,  328 


Typhoid  fever  and  ground-water,  13i 

causation  of,  329 

from  drinking-water,  61 

in  armies,  238 
Typhus  fever,  330 

in  armies,  238 
Tyrotoxicon  in  milk,  95 

Vaccination,  305 

and  syphilis,  311 

mode  of  performing  the  operation, 
309 
Valve-closets,  168 

Vaughan,    V.    C,    on  the  bacillus  ty- 
phoideus  in  drinking-water,  64 
on  poisonous  cheese,  97 
on  tyrotoxicon  as  a  cause  of  cholera 
infantum,  95 
Vaughan's  daily  ration,  83 
Venereal  diseases  in  armies,  239 
Ventilation,  38 

and  heating  of  hospitals,  183 
-    of  prisons,  258 
of  ships,  248 
Vital  statistics,  359 
Voit's  standard  diet-tables,  83 

Waring  system  at  Memphis,  145 
Water-carriage   system   of   sewage   re- 
moval, 144 
Water-closets,  167 
Water  required  by  human  beings,  45 

supply  in  dwellings,  166 
Well-water,  53 
Whisky,  114 

Wilkinson,  Dr.C.  P.,  on  Louisiana  quar- 
antine, 372 
Wines,  115 

Wolpert's  air-tester,  34 
Wyman's  case-record,  189 

Yellow  fever,  331 

causation  of,  332 
Yellow-fever  cordon  in  Texas,  395 


SEPTEMBER,  1891. 


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INDEX  TO  CATALOGUE. 


PAGE 

Annual    of    the    Universal    Medical 

Sciences 27,  28,  29 

Anatomy. 

Practical  Anatomy — Boenning 4 

Structure  of  the  Central  Nervous  Sys- 
tem— Edinger 8 

Charts  of  the  Nervo-Vascular  System — 

Price  and  Eagleton 17 

Synopsis  of  Human  Anatomy— Young  .   .  25 

Bacteriology. 

Bacteriological  Diagnosis — Eisenberg  .   .       8 

Clinical  Charts. 
Improved  Clinical  Charts — Bashore  ...       3 

Consumption. 

Consumption  r  How  to  Prevent  it,  ete. — 
Davis 7 

Domestic  Hygiene,  etc. 

The  Daughter  :  Her  Health,  Education, 

and  Wedlock — Capp 5 

Consumption :  How  to  Prevent  it,  etc. — 

Davis 7 

Plain    Talks    on    Avoided    Subjects — 

Guernsey 9 

Heredity,  Health,  and  Personal  Beauty — 

Shoemaker 21 

Electricity. 

Practical    Electricity    in    Medicine    and 

Surgery— Liebig  and  Rohe 12 

Electricity  in  the  Diseases  of  Women— 
Massey 13 

Fever. 

Fever :   its    Pathology    and    Treatment — 

Hare 10 

Hay  Fever— Sajous 19 

Gynecology. 

Lessons  in  Gynecology — Goodell 9 

Heart,  Lungs,  Kidneys,  etc. 

Diseases   of    the   Heart,    Lungs,    and 

Kidneys— Davis 7 

Diseases  of  the  Heart  and  Circulation  in 

Children— Keating  and  Edwards  ...     12 

Diabetes :    its   Cause,    Symptoms,    and 

Treatment— Purdy 17 

Hygiene. 

American  Resorts — James 11 

Text-Book  of  Hygiene— Rohe 18 

Materia  Medica  and  Thera- 
peutics. 

Hand-Book  of  Materia  Medica,  Phar- 
macy, and  Therapeutics—  Bowen  ...      4 

Ointments  and  Oleates — Shoemaker   ...     21 

Materia  Medica  and  Therapeutics — Shoe- 
maker         22 

International  Pocket  Medical  Formulary 
— Witherstine 26 


(2 


Miscellaneous. 

PAGE 

Book  on  the  Physician  Himself— Cathell .  5 

Oxygen— Demarquay  and  Wallian    ....  7 
Record-Book    of    Medical  Examinations 

for  Life  Insurance — Keating 11 

The  Medical  Bulletin,  Monthly 13 

Physician's  Literpreter 15 

Circumcision — Remondino 18 

Medical  Symbolism— Sozinskey 23 

International  Pocket  Medical  Formulary 

— Witherstine 26 

The   Chinese :    Medical,   Political,    and 

Social — Coltman 31 

A,  B,  C  of  the  Swedish  System  of  Educa- 
tional Gymnastics — Nissen 32 

Lectures  on  Auto-Intoxication — Bouchard  32 

Nervous  System,  Spine,  etc. 

Spinal  Concussion — Clevenger 6 

Structure  of  theCentral  Nervous  System 

— Edinger 8 

Epilepsy  :  its  Pathology  and  Treatment- 
Hare  10 

Lectures  on  Nervous  Diseases — Ranney   .  SO 

Obstetrics. 
Childbed  :  its  Management :  Diseases  and 

Their  Treatment— Manton 13 

Eclampsia — Miehener  and  others 15 

Obstetric  Synopsis— Stewart 14 

Pharmacology . 

Abstracts  of  Pharmacology — Wheeler  .   .     25 

Physiognomy. 

Practical  and  Scientific   Physiognomy — 

Stanton 30 

Physiology. 

Physiology  of  the  Domestic  Animals — 
Smith 23 

Surgery  and  Surgical  Operations. 

Circumcision — Remondino IS 

Principles  of  Surgery — Senn 20 

Swedish  Movement  and  Massage. 

Swedish  Movement  and  Massage  Treat- 
ment— Nissen 15 

Throat  and  Nose. 

Journal  of  Laryngology  and  Rhinology    .  11 

Hay  Fever — Sajous 19 

Diphtheria.  Croup,  etc.— Sanne 19 

Lectures  on  the  Diseases  of  the  Nose  and 

Throat— Sajous 31 

Venereal  Diseases. 

Syphilis  :  To-day  and. in  Antiquity — Buret       4 
Neuroses  of  the  Genito-Urinary  System 
in  the  Male— Ultzmann 24 

Veterinary. 
Age    of   the   Domestic  Animals— Huide- 

koper 32 

Physiology  of  the    Domestic   Animals — 

Smith 23 

Visiting-Lists  and  Account- 
Books. 

Medical  Bulletin  Visiting-List  or  Physi- 
cians' Call-Record 14 

Physicians'  All-Requisite  Account-Book  .     16 

) 


Bashore's  Improved  Clinical  Chart. 

For  the  SEPARATE  PLOTTING  of  TEMPERATURE,  PULSE,  and  RESPIRATION. 

Designed  for  the  Convenient,   Accurate,   and  Permanent  Daily   Recording  of  Cases  in 
Hospital  and  Private  Practice. 

By  HARYEY  B.   BASHORE,   1W.B. 


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D..c,   *Mr.      1    1     1    1    1     1    1     1     1    1    1   »f  *    1     1    1   J-l-L-L. 

COPYRIGHTED,  1888,  BY  F.  A.  DAVIS. 

50  C3aa,zrts„  ioa  TaTolet  I-Tor-aa.  Size,  S  __  12  ioac_a.es 


Price,  in  the  United  States  and  Canada,  Post-paid,  50  Cents, 
Net;  Great  Britain,  2s.  6d.;  France,  3  fr.  60. 

The  above  diagram  is  a  little  more  than  one-fifth  (1-5)  the  actual  size  of  the  chart  and  shows  the 
method  of  plotting,  the  upper  curve  being  the  Temperature,  the  middle  the  Pulse,  and  the  lower  the 
Respiration.     By  this  method  a  full  record  o?  each  can  easily  be  kept  with  but  one  color  ink. 

It  is  so  arranged  that  all  practitioners  will  find  it  an  invaluable  aid  in  the  treatment  of  their  patients. 

On  the  back  of  each  chart  will  be  found  ample  space  conveniently  arranged  for  recording  "  Clinical 
History  and  Symptoms"  and  "Treatment." 

By  its  use  the  physician  will  secure  such  a  complete  record  of  his  cases  as  will  enable  him  to  review 
them  at  any  time.  Thus  he  will  always  have  at  hand  a  source  of  individual  improvement  and  benefit  in 
the  practice  of  his  profession,  the  value  of  which  can  hardly  be  overestimated. 


) 


(F.  A.  DAVIS,  Medical  Publisher,  Philadelphia,  Pa,,  U.S.A.) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 

A  Text-Book  on  Practical  Anatomy. 

Including  a  Section  on  Surgical  Anatomy. 

By  Henry  C.  Boenning,  M.D.,  Lecturer  on  Anatomy  and  Surgery 
in  the  Philadelphia  School  of  Anatomy ;  Demonstrator  of  Anatomy  in 
the  Medico-Chirurgical  College ;  Demonstrator  of  Anatomy  in  the 
Philadelphia  Dental  College  ;  Lecturer  on  Diseases  of  the  Rectum  in 
the  Medico-Chirurgical  College,  etc.,  etc. 

Fully  illustrated  throughout  with  about  200  Wood-Engravings. 
In  one  handsome  Octavo  volume,  printed  in  extra-large,  clear  type, 
making  it  specially  desirable  for  use  in  the  dissecting  room.  Nearly 
500  pages.  Substantial^  bound  in  Extra  Cloth.  Also  in  Oil-Cloth,  for 
use  in  the  dissecting-room  without  soiling. 

Price,  post-paid,  in  the  United  States,  $2.50,  net;  Canada  (duty  paid),  $2.75,  net; 
Great  Britain,  14s. ;  France,  16  fr.  20. 


BOWEN 

Hand-Book  of  Materia  Medica,  Pharmacy, 
and  Therapeutics. 

By  Cuthbert  Bowen.  M.D.,  B.A.,  Editor  of"  Notes  on  Practice." 
Tii-e  second  volume  in  the  Physicians'  and  Students'  Ready  Refer- 

■ence  Series.     One   12mo  volume  of  370  pages.     Handsomely  bound  in 

Dark-Blue  Cloth. 

Price,  post-paid,  in  the  TJnited  States  and  Canada,  $1.40,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  fr.  25. 

EXTRACT  FROM  THE  PREFACE.—"  While  this  is  essentially  a  Student's  Manual, 
a  large  amount  of  matter  has  been  incorporated  which,  it  is  hoped,  will  render  it  a  useful  refer- 
ence-hook to  the  Young  Graduate  who  is  just  entering  on  his  professional  career,  and  more 
particularly  the  individual  whose  sphere  of  work  demands  a  more  practical  acquaintance  with 
pharmaceutical  processes  than  is  required  of  the  ordinary  city  practitioner.  Great  care  has 
Tseen  taken  throughoTit  the  book  to  familiarize  the  student  with  the  best  methods  of  administer- 
ing the  various  drugs  he  will  be  called  upon  to  use,  and  with  this  object  a  large  number  of 
standard  prescriptions  have  been  selected  from  the  works  of  the  most  eminent  authorities, 
which  he  can  either  adopt,  with  modifications  to  siiit  particular  cases,  or  use  as  models  on  which 
to  construct  his  own  formulae." 


This  excellent  manual  comprises  in  its  366 
pages  about  as  much  sound  and  valuable 
information  on  the  subjects  indicated  in  its 
title  as  could  well  be  crowded  into  the  com- 
pass. The  book  is  exhaustively  and  correctly 
indexed,  and  of  a  convenient  form.  The  paper, 
press-work,  and  binding  are  exceUent,  and  the 
typography  (long primer  and  brevier)  is  highly 
to  he  commended,  as  opposed  to  the  nonpareil 
and  agate  usually  used  in  compends  of  this 


sort,  and  which  are  destructive  to  vision  and 
temper  alike. — St.  Louis  Med.  and  Surg.  Jour. 

In  going  through  it,  we  have  been  favorably 
impressed  by  the  plain  and  practical  sugges- 
tions in  regard  to  prescription  writing,  and 
the  metric  system,  and  the  other  things  which 
must  be  known  in  order  to  write  good  and  ac- 
curate prescriptions. — Medical  and  Surgical 
Reporter 


BURET 
Syphilis  :  To-day  and  In  AntiquKy. 

By  Dr.  F.  Buret  (Paris).  Translated  from  the  French,  with  the 
author's  permission,  by  A.  H.  Ohmann-Dumesnil,  A  M.,  M.D.,  Professor 
of  Dermatology  and  Syphilology  in  the  St.  Louis  College  of  Ph}'sicians 
and  Surgeons. 

To  he  completed  in  three  12mo  volumes.  Volume  I,  Syphilis  in 
Antiquity.     In  Press.     Ready  in  October,  1891. 

(4) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


CAPP 


Her  Health,   Education,  and 

Wedlock. 


The  Daughter. 

Homely  Suggestions  to  Mothers  and  Daughters 


By  Willtam  M.  Capp,  M.D.,  Philadelphia.  This  is  just  such  a  book 
as  a  family  physician  would  advise  his  lady  patients  to  obtain  and  read. 
It  answers  man}r  questions  which  every  busy  practitioner  of  medicine 
has  put  to  him  in  the  sick-room  at  a  time  when  it  is  neither  expedient 
nor  wise  to  impart  the  information  sought. 

It  is  complete  in  one  beautifully  printed  (large,  clear  tj-pe)  12tno 
volume  of  150  pages.     Attractively  bound  in  Extra  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net ;  In  Great 
Britain,  5s.  6d. ;  Prance,  6  fr.  20. 


In  the  1-14  pages  allotted  to  him  he  has  com- 
pressed an  amount  of  homely  wisdom  on  the 
physical,  mental,  and  moral  development  of 
the  female  child  from  birth  to  maturity  which 
is  to  be  found  elsewhere  in  only  the  great 
book  of  experience.  It  is,  of  course,  a  book 
for  mothers,  but  is  one  so  void  of  offense  in 
expression  or  ideas  that  it  can  safely  be  recom- 
mended for  all  whose  minds  are  sufficiently 
developed  to  appreciate  its  teachings. — Phila- 
delphia Public  Ledger. 

Many    delicate   subjects   are    treated   with 


skill  and  in  a  manner  which  cannot  strike  any 
one  as  improper  or  bold.  The  absolute  ignor- 
ance in  which  most  young  girls  are  allowed  to 
exist,  even  until  adult  life,  is  often  productive 
of  much  misery,  both  mental  and  physical. 
Quite  a  number  of  books  written  by  physi- 
cians for  popular  use  have  been  prepared  in 
such  a  way  that  the  professional  man  can  read 
between  the  lines  strong  bids  for  popular 
favor,  etc.  These  objectionable  features  will 
not  be  found  in  Dr.  t'app's  brochure,  and  for 
this  reason  it  is  worthy  the  confidence  of 
physicians. — Medical  Neivs. 


CATHJELL 

Book  on  the  Physician  Himself 

And  Things  that  Concern  his  Reputation  and  Success. 

By  D.  W.  Cathell,  M.D.,  Baltimore,  Md.  Being  the  Ninth  Edition 
(enlarged  and  thoroughly  revised)  of  the  "  Physician  Himself,  and  what 
he  should  add  to  his  Scientific  Acquirements  in  order  to  Secure  Success." 
In  one  handsome  Octavo  "Volume  of  298  pages,  bound  in  Extra  Cloth. 

Thousands  of  physicians  have  won  success  in  their  chosen  profession 
through  the  aid  of  this  invaluable  work. 

This  remarkable  book  has  passed  through  eight  (8)  editions  in  less 
than  five  }Tears.  It  has  just  undergone  a  thorough  revison  by  the  author, 
who  has  added  much  new  matter  covering  many  points  and  elucidating 
many  excellent  ideas  not  included  in  former  editions. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net;  in  Great 
Britain,  lis.  6d. ;  Prance,  12  fr.  40. 


I  am  most  favorably  impressed  with  the 
wisdom  and  force  of  the  points  made  in  "The 
Physician  Himself,"  and  believe  the  work  in 
the  hands  of  a  young  graduate  will  greatly  en- 
hance his  chances  for  professional  success. — 
From  Prof.  I).  Hayes  Agneiv,  Phila.,  Pa. 

"We  strongly  advise  every  actual  and  intend- 
ing practitioner  of  medicine  or  surgery  to  have 
"  The  Physician  Himself,"  and  the  more  it  in- 
fluences his  future  conduct  the  better  he  will 
be. — From  the  Canada  Medical  and  Surgical 
Journal,  Montreal. 

In  the  present  edition  the  entire  work  has 
been  revised  and  some  new  matter  introduced. 
The  publisher's  part  is  well  done ;  paper  is 
good  and  the  print  large  ;  altogether  it  is  a 
very  readable  and  enjoyable  book. — Montreal 
Medical  Journal, 


We  have  read  it  carefully  and  regret  much 
that  we  had  not  done  so  earlier  and  followed 
its  precepts.  The  book  is  full  of  good  advice. 
Get  it  at  once. — Pacific  Record  of  Medicine 
and  Surgery. 

We  cannot  imagine  a  more  profitable  invest- 
ment for  the  junior  practitioner  than  the  pur- 
chase and  careful  study  of  "The  Physician 
Himself." — Occidental  Medical  Times. 

To  the  physician  who  has  discovered  that 
there  is  something  else  besides  dry  book-learn- 
ing needed  to  make  him  a  desirable  visitor  at 
the  bedside,  we  commend  this  volume,  that  he 
may  assimilate  some  of  the  ready  crystallized 
worldly  wisdom  which  otherwise  he  may  be 
many  years  acquiring  by  natural  processes. — 
North  Carolina  Medical  Journal. 


(5) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


CLEVENGER 

Spinal  Concussion. 

Surgically   Considered  as  a   Cause   of   Spinal   Injury,  and  Neuro- 

logically  restricted  to  a  certain  symptom  grroup,  for  which 

is  Suggested  the   Designation   Erichsen's  Disease, 

as  One  Form  of  the   Traumatic  Neuroses. 

By  S.  V.  Clevenger,  M.D.,  Consulting  Physician  Reese  and  Alexian 
Hospitals;  Late  Pathologist  County  Insane  Asylum,  Chicago;  Member 
of  numerous  American  Scientific  and  Medical  Societies  ;  Collaborator 
American  Naturalist,  Alienist  and  Neurologist,  Journal  of  Neurology 
and  Psychiatry,  Journal  of  Nervous  and  Mental  Diseases;  author  of 
"  Comparative  Physiology  and  Psychology,"  "  Artistic  Anatomy,"  etc. 

This  work  is  the  outcome  of  five  years' special  study  and  experience 
in  legal  circles,  clinics,  hospital  and  private  practice,  in  addition  to 
twenty  years'  labor  as  a  scientific  student,  writer,  and  teacher. 

The  literature  of  Spinal  Concussion  has  been  increasing  of  late  years 
to  an  unwieldy  shape  for  the  general  student,  and  Dr.  Clevenger  has  in 
this  work  arranged  and  reviewed  all  that  has  been  done  by  observers 
since  the  days  of  Erichsen  and  those  who  preceded  him. 

There  are  abundant  illustrations,  particularly  for  Electro-diagnosis, 
and  to  enable  a  clear  comprehension  of  the  anatomical  and  pathological 
relations. 

The  Chapters  are:  I.  Historical  Introduction;  II.  Erichsen  on 
Spinal  Concussion;  III.  Page  on  Injuries  of  the  Spine  and  Spinal  Cord; 
IV.  Recent  Discussions  of  Spinal  Concussion  ;  V.  Oppenheim  on 
Traumatic  Neuroses;  VI.  Illustrative  Cases  from  Original  and  all  other 
Sources;  VII.  Traumatic  Insanity;  VIII.  The  Spinal  Column;  IX. 
Symptoms;  X.  Diagnosis;  XI.  Pathology;  XII.  Treatment;  XIII. 
Medico-legal  Considerations. 

Other  special  features  consist  in  a  description  of  modern  methods 
of  diagnosis  by  Electricity,  a  discussion  of  the  controversy  concerning 
hysteria,  and  the  author's  original  pathological  view  that  the  lesion  is 
one  involving  the  spinal  sympathetic  nervous  system.  In  this  latter 
respect  entirely  new  ground  is  taken,  and  the  diversity  of  opinion  con- 
cerning the  functional  and  organic  nature  of  the  disease  is  afforded  a 
basis  for  reconciliation. 

Every  Physician  and  Lawyer  should  own  this  work. 

In  one  handsome  Royal  Octavo  Volume  of  nearly  400  pages,  with 
thirty  Wood-Engravings. 

Price,  post-paid,  in  United  States  and  Canada,  $2.50,  net ;  in  Great 
Britain,  14s. ;  in  France,  15  fr. 


The  reader  will  find  in  this  book  the  best 
discussion  and  summary  of  the  facts  on  this 
topic,  which  will  make  it  very  valuable  to 
every  physician.  For  the  specialist  it  is  a 
text-book  that  will  be  often  consulted. — Tlie 
Journal  of  Inebriety. 

The  work  comes  fully  up  to  the  demand, 
and  the  law  and  medical  library,  to  be  com- 
pute, cannot  be  without  it. — Southern  Medical 
Record. 


This  work  really  does,  if  we  may  be  per- 
mitted to  use  a  trite  and  hackneyed  expres- 
sion, "fill  a  long-felt  want."  The  subject  is 
treated  in  all  its  bearings  ;  electro-diagnosis 
receives  a  large  share  of  attention,  and  the 
chapter  devoted  to  illustrative  cases  will  be 
found  to  possess  especial  importance.'  The 
author  has  some  original  views  on  pathology. 
—Medical  Weekly  Review. 


(0) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


Consumption: 


DAVIS 

How  to  Prevent  it,  and  How 
to  t,ive  witli  it. 


Its   Nature,   Causes,  Prevention,  and  the   Mode  of   Life,  Climate, 
Exercise,  Food  and  Clothing  Necessary  for  its  Cure. 

By  N.  S.  Davis,  Jr.,  A.M  ,  M.D.,  Professor  of  Principles  and  Practice  of 
Medicine  in  Chicago  Medical  College;  Physician  to  Mercy  Hospital;  Member  of 
the  American  Medical  Association,  Illinois  State  Medical  Society,  etc.,  etc. 

12mo.     In  Press. 


DAVIS 

Diseases  of  the  Heart,  Lungs,  and  Kidneys. 

By  N.  S.  Davis,  Jr.,  A.M.,  M.D.,  Professor  of  Principles  and  Practice  of 
Medicine  in  Chicago  Medical  College;  Physician  to  Mercy  Hospital;  Member  of 
the  American  Medical  Association,  Illinois  State  Medical  Society,  etc.,  etc. 

In  one  neat  12mo  volume.  No.  in  the  Physicians'  and  Students'  Ready- 
Reference  Series.     In  Preparation. 


DEMARQUAY 

0*        *\  A-  Practical  Investigation  of  the  Clinical 

On   OXYOeno  and  Therapeutic  Value  of  the  Gases 

in  Medical  and  Surgical  Practice, 

With  Especial  Reference  to  the  Value  and  Availability  of  Oxygen, 
Nitrogen,  Hydrogen,  and  Nitrogen  Monoxide. 

By  J.  N.  Demarquay,  Surgeon  to  the  Municipal  Hospital,  Paris,  and  of  the 
Council  of  State;  Member  of  the  Imperial  Society  of  Surgery;  Correspondent  of 
the  Academies  of  Belgium,  Turin,  Munich,  etc  ;  Officer  of  the  Legion  of  Honor, 
Chevalier  of  the  Orders  of  Isabella-the-Catholic  and  of  the  Conception,  of 
Portugal,  etc.  Translated,  with  notes,  additions,  and  omissions,  bjr  Samuel  S. 
Wallian,  A.M.,  M.D.,  Member  of  the  American  Medical  Association;  Ex-Presi- 
dent of  the  Medical  Association  of  Northern  New  York;  Member  of  the  New 
York  County  Medical  Society,  etc. 

In  one  handsome  Octavo  Volume  of  316  pages,  printed  on  fine  paper,  in 
the  best  style  of  the  printer's  art,  and  illustrated  with  21  Wood-Cuts. 

Price,  post-paid,  in  United  States,  Cloth,  $2.00,  net;  Half-Russia,  $3.00, 
net.  In  Canada  (duty  paid),  Cloth,  $2.20,  net;  Half-Russia,  $3.30, 
net.  In  Great  Britain,  Cloth,  lis.  6d. ;  Half-Russia,  17s.  6i  In 
Prance,  Cloth,  12  fr.  40;  Half-Russia,  18  fr.  60. 

For  some  years  past  there  has  been  a  growing  demand  for  something  more 
satisfactory  and  more  practical  in  the  way  of  literature  on  tbe  subject  of  what 
has,  by  common  consent,  come  to  be  termed  "Oxygen  Therapeuties."  On  all 
sides  professional  men  of  standing  and  ability  are  turning  their  attention  to  the 
use  of  the  gaseous  elements  about  us  as  remedies  in  disease,  as  well  as  sustainers 
in  health.  In  prosecuting  their  inquiries,  the  first  hindrance  has  been  the  want 
of  any  reliable,  or  in  any  degree  satisfactory,  literature  on  the  subject. 

This  work,  translated  in  the  main  from  the  French  of  Professor  Demarquay, 
contains  also  a  very  full  account  of  recent  English,  German,  and  American  ex- 
periences, prepared  b3r  Dr.  Samuel  S.  Wallian,  of  New  York,  whose  experience 
in  this  field  antedates  that  of  any  other  American  writer  on  the  subject. 


This  is  a  handsome  volume  of  300  pages,  in 
large  print,  on  good  paper,  and  nicely  illus- 
trated. Although  nominally  pleading  for  the 
use  of  oxygen  inhalations,  the  author  shows  in 
a  philosophical  manner  how  much  greater 
good  physicians  might  do  if  they  more  fully 
appreciated  the  value  of  fresh  air  exercise  and 
water,  especially  in  diseases  of  the  lungs,  kid- 
neys, and  skin.  We  commend  its  perusal  to 
our  readers. — Tfie  Canada  Medical  Record. 


The  book  should  be  widely  read,  for  to  many 
it  will  bring  the  addition  of  a  new  weapon  to 
their  therapeutic  armament. — Northwestern 
Lancet. 

Altogether  the  book  is  a  valuable  one,  which 
will  be  found  of  service  to  the  busv  prac- 
titioner who  wishes  to  keep  abreast  of  the 
improvements  in  therapeutics.  —  Medical 
News. 


(7) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
JEISEWBEBG 

Bacferioioglcal  Diagnosis. 

Tabular  Aids  for  Use  in  Practical  Work. 

By  James  Eisenberg,  Ph.D.,  M.D.,  Vienna.  Translated  and  aug- 
mented, with  the  permission  of  the  author,  from  the  latest  German 
Edition,  by  Norval  H.  Pierce,  M.D.,  Surgeon  to  the  Out-Door  Depart- 
ment of  Michael  Reese  Hospital ;  Assistant  to  Surgical  Clinic,  College 
of  Ph}rsicians  and  Surgeons,  Chicago,  111. 

This  book  is  a  novelty  in  Bacteriological  Science.  It  is  arranged 
in  a  tabular  form  in  which  are  given  the  specific  characteristics  of  the 
various  well-established  bacteria,  so  that  the  worker  maj',  at  a  glance, 
inform  himself  as  to  the  identity  of  a  given  organism.  The}'  then  serve 
the  same  function  to  the  Bacteriologist  as  does  the  "  Chemical  Analysis 
Chart  "  to  the  chemist,  and  the  one  will  be  found  as  essential  as  the 
other. 

The  Greatest  care  has  been  taken  to  bring  the  work  np  to  the 
present  aspect  of  Bacteriolog}^. 

In  one  Octavo  volume,  handsomely  bound  in  Cloth.     Ready  Soon, 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net ;  in  Great 
Britain,  8s.  6d.;  in  France,  9  fr.  35. 


^DINGER 

Twelve  Lectures  on  the  Structure  of  the 
Central  Nervous  System. 

Eor  Physicians  and  Students. 

B}^  Dr.  Ludwig  Edinger,  Frankfort-on-the-Main.  Second  Revised 
Edition.  With  133  Illustrations.  Translated  b}^  Willis  Hall  Vittum, 
M.D.,  St.  Paul,  Minn.  Edited  by  C.  Eugene  Riggs,  A.M.,  M.D.,  Pro- 
fessor of  Mental  and  Nervous  Diseases,  University  of  Minnesota ; 
Member  of  the  American  Neurological  Association. 

The  illustrations  are  exactly  the  same  as  those  used  in  the  latest 
German  edition  (with  the  German  names  translated  into  English),  and 
are  very  satisfactory  to  the  Physician  and  Student  using  the  book. 

The  work  is  complete  in  one  Royal  Octavo  volume  of  about  250 
pages,  bound  in  Extra  Cloth. 

Price  in  United  States  and  Canada,  post-paid,  $1.75,  net ;  Great 
Britain,  10s. ;  France,  12  fr.  20. 


One  of  the  most  instructive  and  valuable 
works  on  the  minute  anatomy  of  the  human 
brain  extant.  It  is  written  in  the  form  of  lec- 
tures, profusely  illustrated,  and  in  clear  lan- 
guage. The  book  is  worthy  of  the  highest 
enconiums,  and  will,  undoubtedly,  command  a 
large  sale. — 77ie  Pacific  Record  of  Medicine 
and  Surgery. 

Since  the  first  works  on  anatomy,  up  to  the 
present  day,  no  work  has  appeared  on  the  sub- 
ject of  the  general  and  minute  anatomy  of  the 
central  nervous  system  so  complete  and  ex- 
haustive as  this  work  of  Dr.  Ludwig  Edinger. 
Being  himself  an  original  worker,  and  having 
the  benefits  of  such  masters  as  Stilling, 
Weigeit,  Geilach,  Meynert,  and  others,  he  has 


succeeded  in  transforming  the  mazy  wilder- 
ness of  nerve  fibres  and  cells  into  a  district  of 
well-marked  pathways  and  centres,  and  by  so 
doing  has  made  a  pleasure  out  of  an  anatomi- 
cal bugbear. — The  Southern  Medical  Record. 

Every  point  is  clearly  dwelt  upon  in  the 
text,  and  where  description  alone  might  leave 
a  subject  obscure  clever  drawings  and  dia- 
grams are  introduced  to  render  misconception 
of  the  author's  meaning  impossible.  The  book 
is  eminently  practical.  It  unravels  the  intri- 
cate entanglement  of  different  tracts  and 
paths  in  a  way  that  no  other  book  has  done  so 
explicitly  or  so  concisely.  —  Northivestern 
Lancet. 


(8) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
GOODELZ 

Lessons  in  Gynecology. 

* 

By  William  Goodell,  A.M.,  M.D.,  etc.,  Professor  of  Clinical  Gyne- 
cology in  the  University  of  Pennsylvania. 

This  exceedingly  valuable  work,  from  one  of  the  most  eminent 
specialists  and  teachers  in  g3'necology  in  the  United  States,  is  now 
offered  to  the  profession  in  a  much  more  complete  condition  than  either 
of  the  previous  editions.  It  embraces  all  the  more  important  diseases 
and  the  principal  operations  in  the  field  of  g}-necology,  and  brings  to 
bear  upon  them  all  the  extensive  practical  experience  and  wide  reading 
of  the  author.  It  is  an  indispensable  guide  to  every  practitioner  who 
has  to  do  with  the  diseases  peculiar  to  women.  Third  Edition.  With 
112  illustrations.  Thoroughly  revised  and  greatly  enlarged.  One  volume, 
large  octavo,  578  pages. 

Price,  in  United  States  and  Canada,  Cloth,  $5.00;  Full  Sheep,  $6.00.    Discount, 

20  per  cent.,  making  it,  net,  Cloth,  $100;  Sheep,  $4.80.    Postage,  27 

cents  estra.     Great  Britain,  Cloth,  22s.  6i  ;  Sheep,  28s., 

post-paid.    France,  30  fr.  80. 

It  is  too  good  a  book  to  have  been  allowed  to 
remain  out  of  print,  and  it  has  unquestionably 
been  missed.  The  author  has  revised  the  work 
with  special  care,  adding  to  each  lesson  such 
fresh  matter  as  the  progress  in  the  art  ren- 
dered necessary,  and  lie  has  enlarged  it  by  the 
insertion  of  six  new  lessons.  This  edition  will, 
without  question,  lie  as  eagerly  sought  for  as 
were  its  predecessors. — American  Journal  of 
Obstetrics. 

His  literary  style  is  peculiarly  charming. 
There  is  a  directness  and  simplicity  about  it 
which  is  easier  to  admire  than  to  copy.  His 
chain  of  plain  words  and  almost  blunt  expres- 
sions, his  familiar  comparison  and  homely 
illustrations,  make  his  writings,  like  his  lec- 


tures, unusually  entertaining.  The  substance 
of  his  teachings  we  regard  as  equally  excel- 
lent.— Philadelphia  Medical  and  Surgical 
Reporter. 

Extended  mention  of  the  contents  of  the 
book  is  unnecessary;  suffice  it  to  say  that 
every  important  disease  found  in  the  female 
sex  is  taken  up  and  discussed  in  a  common- 
sense  kind  of  a  way.  We  wish  every  physician, 
in  America  could  read  and  carry  out  the  sug- 
gestions of  the  chapter  on  "the  sexual  rela- 
tions as  causes  of  uterine  disorders — conjugal 
onanism  and  kindred  sins."  The  department 
treating  of  nervous  counterfeits  of  uterine 
diseases  is  a  most  valuable  one. — Kansas  City 
Medical  Index. 


GUERNSEY 

Plain  Talks  on  Avoided  Subjects. 

By  Henry  N".  Guernsey,  M.D.,  formerly  Professor  of  Materia  Medica 
and  Institutes  in  the  Hahnemann  Medical  College  of  Philadelphia; 
author  of  Guernsey's  "  Obstetrics,"  including  the  Disorders  Peculiar  to 
Women  and  Young  Children  ;  Lectures  on  Materia  Medica,  etc.  The 
following  Table  of  Contents  shows  the  scope  of  the  book : 

Contents. — Chapter  I.  Introductory.  II.  The  Infant.  III.  Child- 
hood. IV.  Adolescence  of  the  Mnle.  V.  Adolescence  of  the  Female. 
VI.  Marriage:  The  Husband.  VII.  The  Wife.  VIII.  Husband  and 
Wife.  IX.  To  the  Unfortunate.  X.  Origin  of  the  Sex.  In  one  neat 
16mo  volume,  bound  in  Extra  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00 ;  Great  Britain, 

6s. ;  France,  6  fr.  20. 

O) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia.  ^ 


HABE 

Epilepsy:  Its  Pathology  and  Treatment. 

Being  an  Essay  to  which  was  Awarded  a  Prize  of  Four  Thousand 

Francs  by  the  Academie  Royale  de  Medecine  de  Belgique, 

December  31,  1889. 

By  Hobart  Amort  Hare,  M.D.  (Univ.  of  Penna.),  B.Sc,  Professor  of 
Materia  Medica  and  Therapeutics  in  the  Jefferson  Medical  College,  Phila.  ; 
Physician  to  St.  Asnes'  Hospital  and  to  the  Children's  Dispensary  of  the  Chil- 
dren's Hospital  ;  Laureate  of  the  Royal  Academy  of  Medicine  in  Belgium,  of 
the  Medical  Society  of  London,  etc.  ;  Member  of  the  Association  of  American 
Physicians. 

No.  7  in  the  Physicians'  and  Students'  Ready -Reference  Series.  12mo.  228 
pages.     Neatly  bound  in  Dark -blue  Cloth. 

Price,  post-paid,  in  United  States  and  Canada,  $1.25,  net;  in  Great 
Britain,  6s.  6d. ;  in  France,  7  fr.  75. 

It  is  representative  of  the  most  advanced  : '  It  is  remarkable  for  its  clearness,  brevity,  and 

views  of  the  profession,   and  the  subject  is  beauty  of  style.     It  is,  so  far  as  the  reviewer 

pruned  of  the  vast  amount  of  superstition  and  '   knows,  altogether  the  best  essay  ever  written 

nonsense  that  generallv  obtains  in  connection  upon   this   important  subject.—  Kansas    City 

with  epilepsy.—  Medical  Age.  :     Medical  Index. 

Every  physician  who  would  get  at  the  gist  nrenarine-  the  work  must  have 

of  all  that  is  worth  knowing  on  epilepsv,  and        ,    ine  tas*  or  preparing  trie  wotk  must  nave 

Kg  BSyffiSSSS  SSg&S  appreciation  of  ^  work^e^fess ion  ; 

aanuai  tan.  ,    ^ave  not  kept  abreast  with  the  recent  litera- 

It  contains  all  that  is  known  of  the  pathology  ture  upon  this  subject.    Indeed,  the  work  is  a 

of  this  strange  disorder,  a  clear  discussion  of  sort  of   Dictionary  of    epilepsy— a  reference 

the  diagnosis  from  allied  neuroses,  and  the  guide-book  upon  the  subject.— Alienist  and 

very  latest  therapeutic  measures  for  relief.  II   Neurologist. 


MABE 

Fever:  Its  Pathology  and  Treatment. 

Being  the  Boylston  Prize  Essay  of  Harvard  University  for  1890. 
Containing  Directions  and  the  Latest  Information  Con- 
cerning  the   Use  of  the   So-Called   Anti- 
pyretics in  Fever  and  Pain. 

By  Hobart  Amort  Hare,  M.D.  (Univ.  of  Penna.),  B.Sc,  Professor  of 
Materia  Medica  and  Therapeutics  in  the  Jefferson  Medical  College,  Phila.; 
Physician  to  St.  Agnes'  Hospital  and  to  the  Children's  Dispensary  of  the  Chil- 
dren's Hospital;  Laureate  of  the  Royal  Academy  of  Medicine  in  Belgium,  of  the 
Medical  Society  of  London,  etc.;  Member  of  the  Association  of  American 
Physicians. 

No.  10  in  the  Physicians'  and.  Students'  Ready-Reference  Series.  12mo. 
Keatly  bound  in  Dark-blue  Cloth. 

Illustrated  with  more  than  25  new  plates  of  tracings  of  various  fever  cases, 
showing  beautifully  and  accurately  the  action  of  the  Antipyretics.  The  work 
also  contains  35  carefully  prepared  statistical  tables  of  249  cases  showing  the 
untoward  effects  of  the  antipyretics. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.25,  net;  in  Great  Britain, 
6s.  6i ;  in  France,  7  fr.  75. 

As  is  usual  with  this  author,  the  subject  is  the  most  interesting  of  its  excellent  group, 

thoroughlv  handled,  anil  much  experimental  the  Physicians'  and  Students'   Ready-Refer- 

and  Clinical  evidence,  both  from  the  author's  ence  Series.— Tfie  Dosimetric  Medical  Review. 
experience  and  that  of  others,  is  adduced  in 

an  pport  of  the  view  taken.— New  York  Medical  \       Such  books  as  the  present  one  are  of  service 

Abstract.  <     to  the  student,  the  scientific  therapeutist,  and 

the  general  practitioner  alike,  for  much  can 

The  author  has  done  an  able  piece  of  work  /   be  found  of  real  value  in  Dr.  Hare's  book,  with 

in  showing  the  facts  as  far  as  they  are  knov,  n  the  additional  advantage  that  it  is  up  to  the 

concerning    the    action    of    antipyrin.    anti-  latest   researches  upon  the  subject.—  Univer- 

febrin.  phenacetin,  thallin,  and  salicylic  acid.  sity  Medical  Magazine. 

The  reader  will  certainly  find  the  work  one  of  || 

(10) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia.  \ 

JAMES 

American    RcSOliS.   With  Notes  upon  their  Climate. 

By  Bushrod  W.  James,  A.M.,  M.D.,  Member  of  the  American  Public 
Health  Association,  and  the  Academy  of  Natural  Sciences,  Philadelphia;  the 
Society  of  Alaskan  Natural  History  and  Ethnology,  Sitka,  Alaska,  etc.  With 
a  translation  from  the  German,  by  Mr.  S.  Kauffmann,  of  those  chapters  of  "Die 
Klimate  der  Erde  "  written  by  Dr.  A.  Woeikof,  of  St.  Petersburg,  Russia,  that 
relate  to  North  and  South  America  and  the  Islands  and  Oceans  contiguous  thereto. 

This  is  a  unique  and  valuable  work,  and  useful  to  physicians  in  all  parts  of 
the  country.  We  mention  a  few  of  the  merits  it  possesses:  First.  List  of 
all  the  Health  Resorts  of  the  country,  arranged  according  to  their  climate. 
Second.  Contains  just  the  information  needed  by  tourists,  invalids,  and  those  who 
visit  summer  or  winter  resorts.  Third.  The  latest  and  best  large  railroad  map  for 
reference.  Fourth.  It  indicates  the  climate  each  one  should  select  for  health. 
Fifth.  The  author  has  traveled  extensively,  and  most  of  his  suggestions  are 
practical  in  reference  to  localties.  In  one  Octavo  volume.  Handsomely  bound 
in  Cloth.     Nearly  300  pages. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net; 
Great  Britain,  lis.  6d. ;  Prance,  12  fr.  40. 

Taken  altogether,  this  is  by  far  the  most 
complete  exposition  of  the  subject  of  resorts 
that  has  yet  been  put  forth,  and  it  is  one  that 
every  physician  must  needs  possess  intelligent 
information  upon.Suffalo  Med.  &  Surg.  Jour. 

The  special  chapter  on  the  therapeutics  of 
clhr  ate  .  .  is  excellent  for  its  precautionary 
suggestions  in  the  selection  of  climates  and 
local   conditions,    with   reference   to   known 


pathological    indications    and   constitutional 
predispositions. — The  Sanitarian. 

The  book  before  us  is  a  very  comprehensive 
volume,  giving  all  necessary  information  con- 
cerning climate,  temperature,  humidity,  sun- 
shine, and  indeed  everything  necessary  to  be 
stated  for  the  benefit  of  the  physician  or 
invalid  seeking  a  health  resort  in  the  United 
States. — Southern  Clinic. 


Journal  of  Laryngology  and  Rhinology. 

Issued  on  the  First  of  Each  Month. 

Edited  by  Dr.  Norris  Wolfenden,  of  London,  and  Dr.  John  Macintyre,  of 
Glasgow,  with  the  active  aid  and  co-operation  of  Drs.  Dundas  Grant,  Barclay  J. 
Baron,  Hunter  Mackenzie,  and  Sir  Morell  Mackenzie.  Besides  those  specialists 
in  Europe  and  America  who  have  so  ably  assisted  in  the  collaboration^  the 
Journal,  a  number  of  new  correspondents  have  undertaken  to  assist  the  editors  in 
keeping  the  Journal  up  to  date,  and  furnishing  it  with  matters  of  interest. 
Amongst  these  are:  Drs.  Sajous,  of  Philadelphia;  Middlemass  Hunt,  of  Liver- 
pool; Mellow,  of  Rio  Janeiro;  Sedziak,  of  Warsaw;  Draispul,  of  St.  Petersburg, 
etc.  Drs.  Michael,  Joal,  Holger,  Mygind,  Prof.  Massei,  and  Dr.  Valerius  Idelson 
will  still  collaborate  the  literature  of  their  respective  countries. 

Price,  13s.  or  $3.00  per  annum  (inclusive  of  Postage).    For  single  copies,  however,  a 
charge  of  Is.  3d.  (30  cents)  will  be  made.    Sample  Copy,  25  Cents. 


KEATING 

Record-Book  of  Medical  Examinations 

For  Life  Insurance. 

Designed  by  John  M.  Keating,  M.D. 

This  record-book  is  small,  neat,  and  complete,  and  embraces  all  the  prin- 
cipal points  that  are  required  by  the  different  companies.  It  is  made  in  two  sizes, 
viz.:  No.  1,  covering  one  hundred  (100)  examinations,  and  No.  2,  covering  two 
hundred  (200)  examinations.  The  size  of  the  book  is  7x3f  inches,  and  can  be 
conveniently  carried  in  the  pocket. 

U.  S.  and  Canada.         Great  Britain.      France. 

No.  1.    For  100  Examinations,  in  Cloth,    -    -    $  .50  Net  3s.  6d,        3  fr.  60 

No.  2.   For  200  Examinations,  in  Full 

Leather,  with  Side  Flap,    -    -    -    -      1.00    "  6s.  6fr.  20 

(in 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


KEATING  and  EDWARDS 

Diseases  of  the  Heart  and  Circulation. 

In  Infancy  and  Adolescence.     With  an  Appendix  entitled  "  Clinical 
Studies  on  the  Pulse  in  Childhood." 

By  John  M.  Keating,  M.D.,  Obstetrician  to  the  Philadelphia  Hospital, 
and  Lecturer  on  Diseases  of  Women  and  Children;  Surgeon  to  the  Maternity 
Hospital;  Physician  to  St.  Joseph's  Hospital;  Fellow  of  the  College  of  Physicians 
of  Philadelphia,  etc.;  and  William  A.  Edwards,  M.D.,  Instructor  in  Clinical 
Medicine  and  Physician  to  the  Medical  Dispensary  in  the  University  of 
Pennsylvania;  Physician  to  St.  Joseph's  Hospital;  Fellow  of  the  College  of 
Physicians;  formerly  Assistant  Pathologist  to  the  Philadelphia  Hospital,  etc. 

Illustrated  by  Photographs  and  Wood-Engravings.  About  225  pages.  Oc- 
tavo.    Bound  in  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  Sd. ;  in  France,  9  fr.  35. 


Drs.  Keating  and  Edwards  have  produced  a 
work  that  will  give  material  aid  to  every 
doctor  in  his  practice  among  children.  The 
style  of  the  book  is  graphic  and  pleasing,  the 
diagnostic  points  are  explicit  and  exact,  and 
the  therapeutical  resources  include  the  novel- 
ties of  medicine  as  well  as  the  old  and  tried 
agents. — Pittsburgh  Med.  Review. 


It  is  not  a  mere  compilation,  but  a  systematic 
treatise,  and  bears  evidence  of  considerable 
labor  and  observation  on  the  part  of  the 
authors.  Two  fine  photographs  of  dissections 
exhibit  mitral  stenosis  and  mitral  regurgita- 
tion ;  there  are  also  a  number  of  wood-cuts. 
— Cleveland  Medical  Gazette. 


LIEBIG  and  ROHE 


Practical  Electricity  in  Medicine  $  Surgery. 

By  G.  A.  Liebig,  Jr.,  Ph  D.,  Assistant  in  Electricity,  Johns  Hopkins 
University  ;  Lecturer  on  Medical  Electricity,  College  of  Physicians  and  Surgeons, 
Baltimore  ;  Member  of  the  American  Institute  of  Electrical  Engineers,  etc.  ;  and 
George  H.  Rohe,  M.D.,  Professor  of  Obstetrics  and  Hygiene,  College  of  Physi- 
cians and  Surgeons,  Baltimore  ;  Visiting  Physician  to  Bay  View  and  City  Hos- 
pitals ;  Director  of  the  Maryland  Maternite  ;  Associate  Editor  "Annual  of  the 
Universal  Medical  Sciences,"  etc. 

Profusely  Illustrated  by  Wood-Engravings  and  Original  Diagrams,  and 
published  in  one  handsome  Royal  Octavo  volume  of  383  pages,  bound  in  Extra 
Cloth. 

The  constantly  increasing  demand  for  this  work  attests  its  thorough  relia- 
bility and  its  popularity  with  the  profession,  and  points  to  the  fact  that  it  is 
already  the  standard  work  on  this  very  important  subject.  The  part  on  Physical 
Electricity,  written  by  Dr.  Liebig,  one  of  the  recognized  authorities  on  the 
science  in  the  United  States,  treats  fully  such  topics  of  interest  as  Storage  Bat- 
teries, Dynamos,  the  Electric  Light,  and  the  Principles  and  Practice  of  Electrical 
Measurement  in  their  Relations  to  Medical  Practice.  Professor  Robe,  who  writes 
on  Electro-Therapeutics,  discusses  at  length  the  recent  developments  of  Electricity 
in  the  treatment  of  stricture,  enlarged  prostate,  uterine  fibroids,  pelvic  cellulitis, 
and  other  diseases  of  the  male  and  female  genito-urinary  organs.  The  applica- 
tions of  Electricity  in  dermatology,  as  well  as  in  the  diseases  of  the  nervous 
system,  are  also  fully  considered. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net ;  in  Great 
Britain,  lis.  6d. ;  France,  12  fr.  40. 

In  its  perusal,  with  each  succeeding  page, 
we  have  been  more  and  more  impressed  with 
the  fact  that  here,  at  last,  we  have  a  treatise 
on  electricity  in  medicine  and  surgery  which 
amply  fulfills  its  purpose,  and  which  is  sure  of 
general  adoption  by  reason  of  its  thorough 
excellence  and  superiority  to  other  works  in- 
tended to  cover  the  same  field. — Pharmaceu- 
tical Era. 

After  carefully  looking  over  this  work,  we 
incline  to  the  belief  that  the  intelligent  physi- 
cian who  is  familiar  with  the  general  subject 
will  be  greatly  interested  and  profited. — 
American  Lancet. 


Any  physician,  especially  if  he  be  a  beginner 
in  electro-therapeutics,  will  be  well  repaid  by 
a  careful  study  of  this  work  by  Liebig  and 
Rohe.  For  a  work  on  a  special  subject  the 
price  is  low,  and  no  one  can  give  a  good  ex- 
cuse for  remaining  in  ignorance  of  so  impor- 
tant a  subject  as  electricity  in  medicine. — 
Toledo  Medical  and  Surgical  Reporter. 

The  entire  work  is  thoroughly  scientific  and 
practical,  and  is  really  what' the  authors  have 
aimed  to  produce,  "a  trustworthy  guide  to 
the  application  of  electricitv  in  the  practice  of 
medicine  and  Surgery."— --New  York  Medical 
Times. 


(12) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


MASSB T 

Electricity  in  the  Diseases  of  Women. 

With   Special  Reference  to  the  Application  of  Strong  Currents. 

By  G.  Betton  Massey,  M.D.,  Physician  to  the  Gynaecological  Department 
of  the  Howard  Hospital ;  late  Electro-therapeutist  to  the  Philadelphia  Orthopaedic 
Hospital  and  Infirmary  for  Nervous  Diseases  ;  Member  of  the  American  Neuro- 
logical Association,  of  the  Philadelphia  Neurological  Society,  of  the  Franklin 
Institute,  etc.  Second  Edition.  Revised  and  Enlarged.  With  New  and 
Original  Wood-Engravings.-  Handsomely  bound  in  Dark-Blue  Cloth.  240  pages. 
12mo.     JVo.  5  in  the  Physicians'  and  Students'  Ready -Reference  Series. 

This  work  is  presented  to  the  profession  as  the  most  complete  treatise  yet 
issued  on  the  electrical  treatment  of  the  diseases  of  women,  and  is  destined  to 
fill  the  increasing  demand  for  clear  and  practical  instruction  in  the  handling  and 
use  of  strong  currents  after  the  recent  methods  first  advocated  by  Apostoli.  The 
whole  subject  is  treated  from  the  present  stand-point  of  electric  science  with  new 
and  original  illustrations,  the  thorough  studies  of  the  author  and  his  wide  clinical 
experience  rendering  him  an  authority  upon  electricity  itself  and  its  therapeutic 
applications.  The  author  has  enhanced  the  practical  value  of  the  work  by 
including  the  exact  details  of  treatment  and  results  in  a  number  of  cases  taken  from 
his  private  and  hospital  practice. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net ;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  fr.  35. 

that  the  improvements  introduced  into  this 
edition  make  it  more  valuable  still. — Boston 
Medical  and  Surgical  Journ. 


A  new  edition  of  this  practical  manual  at- 
tests the  utility  of  its  existence  and  the  recog- 
nition of  its  merit.  The  directions  are  simple, 
easy  to  follow  and  to  put  into  practice  ;  the 
ground  is  well  covered,  and  nothing  is  assumed, 
the  entire  book  being  the  record  of  experience. 
— Journal  of  Nervous  and  Mental  Diseases. 

It  is  only  a  few  months  since  we  noticed  the 
first  edition  of  this  little  book ;  and  it  is  only 
necessary  to  add  now  that  we  consider  it  the 
best  treatise  on  this  subject  we  have  seen,  and 


The  style  is  clear,  but  condensed.  Useless 
detaile  are  omitted,  the  reports  of  cases  being 
pruned  of  all  irrelevant  material.  The  book 
is  an  exceedingly  valuable  one,  and  represents 
an  amount  of  study  and  experience  which  is 
only  appreciated  after  a  careful  reading.— 
Medical  Record. 


MA1TTOW 

Childbed;  Its  Management;  Diseases  and 
Their  Treatment. 

By  Walter  P.  Manton,  M.D.,  Visiting  Physician  to  the  Detroit  Woman's 
Hospital  ;  Consulting  Gj^naecologist  to  the  Eastern  Michigan  Asylum;  President 
of  the  Detroit  Gynaecological  Society  ;  Fellow  of  the  American  Society  of  Ob- 
stetricians and  Gynaecologists,  and  of  the  British  Gynaecological  Society  ;  Member 
of  Michigan  State  Medical  Society,  etc.  In  one  neat  12mo  volume,  No.  in 
the  Physicians'  and  Students'  Ready -Reference  Series.     In  Preparation. 


Medical  Bulletin. 

A  Monthly  Journal  of  Medicine  and  Surgery. 

Edited  by  John  V.  Shoemaker,  A.M.,  M.D.  Bright,  original,  and  read- 
able. Articles  by  the  best  practical  writers  procurable.  Every  article  as  brief  as 
is  consistent  with  the  preservation  of  its  scientific  value.  Therapeutic  Notes  by 
the  leaders  of  the  medical  profession  throughout  the  world.  These,  and  many 
other  unique  features,  help  to  keep  The  Medical  Bulletin  in  its  present 
position  as  the  leading  low-price  Medical  Monthly  of  the  world.     Subscribe  now. 

TEEMS :  $1.00  a  year  in  advance  in  United  States,  Canada,  and  Mexico. 
Foreign  Subscription  Terms :  England,  5s. ;  France,  6  fr. ;  Germany, 
6  marks;  Japan,  1  yen;  Australia,  5s.;  Holland,  3  florins. 

(13) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


The  Medical  Bulletin  Visiting-List  or 
Physicians'  Call  Record. 

Arranged  upon  an  Original  and  Convenient  Monthly  and  Weekly 
Plan  for  the  Daily  Recording  op  Professional  Yisits. 


Frequent  Rewriting  of  Names  Unnecessary. 

THIS  Visiting-List  is  arranged  so  that  the  names  of  patients  need  he  written 
hnt  once  a  month  instead  of  four  times  a  month,  as  in  the  old-style  lists. 
By  means  of  a  new  feature,  a  simple  device  consisting  of  stub  or  half 
leaves  in  the  form  of  inserts,  the  first  week's  visits  are  recorded  in  the  usual 
way,  and  the  second  week's  visits  are  begun  hy  simply  turning  over  the  half-leaf 
without  the  necessity  of  rewriting  the  patients'  names.  This  very  easily  under- 
stood process  is  repeated  until  the  month  is  ended  and  the  record  has  heen  kept 
complete  in  every  detail  of  visit,  charge,  credit,  etc.,  and  the  labor  and  time 
of  entering  and  transferring  names  at  least  three  times  in  the  month  has  been 
saved.  There  are  no  intricate  rulings  ;  not  the  least  amount  of  time  can  be  lost 
in  comprehending  the  plan,  for  it  is  acquired  at  a  glance. 

THE  THREE  DIFFERENT  STYLES  MADE. 

The  No.  1  Style  of  this  List  provides  space  for  the  daily  record  of  seventy 
different  names  each  month  for  a  year  ;  for  physicians  who  prefer  a  List  that  will 
accommodate  a  larger  practice  we  have  made  a  No.  2  Style,  which  provides 
space  for  the  daily  record  of  105.  different  names  each  month  for  a  year,  and  for 
physicians  who  may  prefer  a  Pocket  Record-Book  of  less  thickness  than  either  of 
these  styles  we  have  made  a  No.  3  Style,  in  which  "The  Blanks  for  the  Record- 
ing of  Visits  in  "  have  been  made  into  removable  sections.  These  sections  are 
very  thin,  and  are  made  up  so  as  to  answer  in  full  the  demand  of  the  largest 
practice,  each  section  providing  ample  space  for  the  daily  record  of  210  dif- 
ferent names  for  two  months T;  or  105  different  names  daily  each  month  for  four 
months  ;  or  seventy  different  names  daily  each  month  for  six  months.  Six  sets 
of  these  sections  go  with  each  copy  of  No.  3  Style. 

SPECIAL  FEATURES  NOT  FOUND  IN  ANY  OTHER  LIST. 

In  this  No.  3  Style  the  printed  matter,  and  such  matter  as  the  blank 
forms  for  Addresses  of  Patients,  Obstetric  Record,  Vaccination  Record, 
Cash  Account,  Birth  and  Death  Records,  etc.,  are  fastened  permanently  in  the 
back  of  the  book,  thus  reducing  its  thickness.  The  addition  of  one  of  these 
removable  sections  does  not  increase  the  thickness  more  than  an  eighth  of  an  inch. 
This  brings  the  book  into  such  a  small  compass  that  no  one  can  object  to  it  on 
account  of  its  thickness,  as  its  bulk  is  very  much  less  than  that  of  any  visiting- 
list  ever  published.  Every  physician  will  at  once  understand  that  as  soon  as  a 
section  is  full  it  can  be  taken  out,  filed  away,  and  another  inserted  without  the 
least  inconvenience  or  trouble.  Extra  or  additional  sections  will  be  furnished  at 
any  time  for  15  cents  each  or  $1.75  per  dozen.  This  Visiting-List  contains  calen- 
dars, valuable  miscellaneous  data,  important  tables,  and  other  useful  printed 
matter  usually  placed  in  Physicians'  Visiting-Lists. 

Physicians  of  many  years'  standing  and  with  large  practices  pronounce  it 
the  Best  List  they  have  ever  seen.  It  is  handsomely  bound  in  fine,  strong 
leather,  with  flap,  including  a  pocket  for  loose  memoranda,  etc.,  and  is  furnished 
with  a  Dixon  lead-pencil  of  excellent  quality  and  finish.  It  is  compact  and  con- 
venient for  carrying  in  the  pocket.     Size,  4x6|  inches. 

I3ST    THRKK    STYLES.  net  prices. 

"So.  1.  Regular  size,  to  accommodate  70  patients  daily  each  month  for  one  year,  .  .  .  ¥1.25 
So.  2.  Large  size,  to  accommodate  105  patients  daily  each  month  for  one  year,  ....  $1.50 
No.  3.     In  which  the  "  Blanks  for  Recording  Visits  in  "  are  in  removable  sections,  .     .     .     SI. 75 

Special  Edition  for  Great  Britain,  without  printed  matter,        4s.  6d. 

m     N.  B.—The  Recording  of  Visits  in  this  List  may  be  Commenced  at  any  time  during  the  Year. 

(14) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


3IICHENJEIt 

Hand-Book  of  Eclampsia; '  R,°foif§^iy£Si 

By  E.  Michener,  M.D.  ;  J.  II.  Stubbs,  M.D.  ;  R.  B.  Ewing,  M.D. ;  B. 
Thompson,  M.D.  ;  S.  Stebbins,  M.D.     16mo.     Cloth. 

Price,  60  cents,  net ;  in  Great  Britain,  4s.  6i ;  France,  4  fr.  20. 


NISSMN 
A  MANUAL  OF  INSTRUCTION   FOR   GIVING 

Swedish  Movement  a£d  Massage  Treatment 

By  Prop.  Hartvig  Nissen,  late  Director  of  the  Swedish  Health  Institute, 
Washington,  D.  C.  ;  late  Instructor  in  Physical  Culture  and  Gymnastics  at  the 
Johns  Hopkins  University,  Baltimore,  Md.  ;  Instructor  of  Swedish  and  German 
Gymnastics  at  Harvard  University's  Summer  School,  1891. 

This  excellent  little  volume  treats  this  very  important  subject  in  a  practical 
manner.  Full  instructions  are  given  regarding  the  mode  of  applying  the  Swedish 
Movement  and  Massage  Treatment  in  various  diseases  and  conditions  of  the 
human  system  with  the  greatest  degree  of  effectiveness.  Professor  Nissen  is  the 
best  authority  in  the  United  States  upon  the  practical  phase  of  this  subject,  and 
his  book  is  indispensable  to  every  physician  who  wishes  to  know  how  to  use  these 
valuable  handmaids  of  medicine. 

Illustrated  with  29  Original  Wood-Engravings.  In  one  12mo  volume  of 
128  Pages.     Neatly  bound  in  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net; 
Great  Britain,  6s. ;  France,  6  fr.  20. 


This  manual  is  valuable  to  the  practitioner, 
as  it  contains  a  terse  description  of  a  subject 
but  too  little  understood  in  this  country.  .  . 
The  book  is  got  up  very  creditably. — N.  Y. 
Med.  Jour. 

The  present  volume  is  a  modest  account  of 
the  application  of  the  Swedish  Movement  aud 
Massage  Treatment,  in  which  the  technique  of 


the  various  procedures  are  clearly  stated  as 
well  as  illustrated  in  a  very  excellent  manner. 
— North  American  Practitioner. 

This  attractive  little  book  presents  the  sub- 
ject in  a  very  practical  shape,  and  makes  it 
possible  for  every  physician  to  understand  at 
least  how  it  is  applied,  if  it  does  not  g've  him 
dexterity  in  the  art  of  its  application. — Chicago 
Med.  limes. 


Physicians'  Interpreter. 

In  Four  Languages  (English,  French,  German,  and  Italian). 
Specially  Arranged  for  Diagnosis  by  M.  yon  V. 

The  object  of  this  little  work  is  to  meet  a  need  often  keenly  felt  by  the  busy 
physician,  namely,  the  need  of  some  quick  and  reliable  method  of  communicating 
intelligibly  with  patients  of  those  nationalities  and  languages  unfamiliar  to  the 
practitioner.  The  plan  of  the  book  is  a  systematic  arrangement  of  questions 
upon  the  various  branches  of  Practical  Medicine,  and  each  question  is  so  worded 
that  the  only  answer  required  of  the  patient  is  merely  Yes  or  No.  The  questions 
are  all  numbered,  and  a  complete  Index  renders  them  always  available  for  quick 
reference.  The  book  is  written  by  one  who  is  well  versed  in  English,  French, 
German,  and  Italian,  being  an  excellent  teacher  in  all  those  languages,  and  who 
has  also  had  considerable  hospital  experience.  Bound  in  Full  Russia  Leather, 
for  carrying  in  the  pocket.     Size,  5x2|  inches.     206  pages. 

Price,  post-paid,  in  United  States  and  Canada,  $1.00,  net ;  Great 
Britain,  6s. ;  France,  6  fr.  20. 


Many  other  books  of  the  same  sort,  with 
more  extensive  vocabularies,  have  been  pub- 
lished, but,  from  their  size,  and  from  their 
being  usually  devoted  to  equivalants  in  Eng- 
lish and  one'  other  language  only,  they  have 
not  had  the  advantage  which  is  pre-eminent 
in  this— convenience.  It  is  handsomely  printed, 
and  bound  in  flexible  red  leather  in  the  form 
of  a  diary.  It  would  scarcely  make  itself  felt 
in  one's  hip-pocket,  and  would  insure  its 
bearer  against   any   ordinary  conversational 


difficulty  in  dealing  with  foreign-speaking 
people,  who  are  constantly  coming  into  our 
city  hospitals.— New  York  Medical  Journal. 

This  little  volume  is  one  of  the  most  inge- 
nious aids  to  the  physician  which  we  have 
seen.  We  heartily  commend  the  book  to  any 
one  who,  being  without  a  knowledge  of  the 
foreign  languages,  is  obliged  to  treat  those 
who  do  not  know  our  own  language.— <Stt.  Louis 
Courier  of  Medicine, 


(15) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


Physician's  All-Requisite  Time-  and  Labor- 
Saving  Account-Book. 

Being  a   Ledger   and  Account-Book  for   Physicians'   Use,  Meeting 
all  the  Requirements  op  the  Law  and  Courts. 

Designed  by  William  A.  Seibert,  M.D  ,  of  Easton,  Pa. 

Probably  no  class  of  people  lose  more  money  through  carelessly  kept 
accounts  and  overlooked  or  neglected  bills  than  physicians.  Often  detained  at 
the  bedside  of  the  sick  until  late  at  night,  or  deprived  of  even  a  modicum  of  rest, 
it  is  with  great  difficulty  that  he  spares  the  time  or  puts  himself  in  condition  to 
give  the  same  care  to  his  own  financial  interests  that  a  merchant,  a  lawyer,  or 
even  a  farmer  devotes.  It  is  then  plainly  apparent  that  a  system  of  bookkeeping 
and  accounts  that,  without  sacrificing  accuracy,  but,  on  the  other  hand,  ensuring 
it,  at  the  same  time  relieves  the  keeping  of  a  physician's  book  of  half  their 
complexity  and  two-thirds  the  labor,  is  a  convenience  which  will  be  eagerly 
welcomed  by  thousands  of  overworked  physicians.  Such  a  system  has  at  last 
been  devised,  and  we  take  pleasure  in  offering  it  to  the  profession  in  the  form  of 
The  Physician's  All-Requisite  Time-  and  Labor-  Saving  Account-Book. 

There  is  no  exaggeration  in  stating  that  this  Account-Book  and  Ledger 
reduces  the  labor  of  keeping  your  accounts  more  than  one -half,  and  at  the  same 
time  secures  the  greatest  degree  of  accuracy.  We  may  mention  a  few  of  the 
superior  advantages  of  The  Physician's  All-Requisite  Time-  and  Labor-  Saving 
Account-Book,  as  follows  : — 


First — Will  meet  all  the  requirements 
of  the  law  and  courts. 

Second — Self-explanatory  ;  no  cipher 
code. 

Third — Its  completeness  without  sacri- 
ficing anything. 

Fourth — No  posting  ;  one  entry  only. 

Fifth — Universal ;  can  be  commenced  at 
any  time  of  the  year,  and  can  be 
continued  indefinitely  until  every 
account  is  filled. 

Sixth — Absolutely  no  waste  of  space. 

Seventh — One  person  must  needs  be 
sick  every  day  of  the  year  to  fill 
his  account,  or  might  be  ten  years 
about  it  and  require  no  more  than 
the  space  for  one  account  in  this 
ledger. 

Eighth — Double  the  number  and  many 
times  more  than  the  number  of  ac- 


counts in  any  similar  book  ;  the 
300-page  book  contains  space  for 
900  accounts,  and  the  600-page 
book  contains  space  for  1800  ac- 
counts. 

Ninth — There  are  no  smaller  spaces. 

Tenth — Compact  witbout  sacrificing 
completeness  ;  every  account  com- 
plete on  same  page — a  decided  ad- 
vantage and  recommendation. 

Eleventh — Uniform  size  of  leaves. 

Twelfth — The  statement  of  the  most 
complicated  account  is  at  once  be- 
fore you  at  any  time  of  month  or 
year — in  other  words,  the  account 
itself  as  it  stands  is  its  simplest 
statement. 

Thirteenth — No  transferring  of  accounts, 
balances,  etc. 


To  all  physicians  desiring  a  quick,  accurate,  and  comprehensive  method  of 
keeping  their  accounts,  we  can  safely  say  that  no  book  as  suitable  as  this  one  has 
ever  been  devised.  A  descriptive  circular  showing  the  plan  of  the  book  will  be 
sent  on  application. 


NET  PRICES,  SHIPPING  EXPENSES  PREPAID. 

No.  1.  300  Pages,  for  900  Accounts  per  Year,  Canada 

Size  10x12,  Bound  in  X-Russia,  Raised  inu.s.  (duty  paid). 

Back-Bands,  Cloth  Sides,        .       .       .  $5.00        $5.50 
No.  2.  600  Pages,  for  1800  Acoounts  per  Year, 

Size  10zl2,  Bound  in  U -Russia,  Raised 

Back-Bands,  Cloth  Sides,               .       .  8.00          8.80 

(16) 


Great 
Britain. 

28s. 


France. 

30  fr.  30 


42s.        49  fr.  40 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


PRICE  and  BAGLETON 

Three  Charts  of  the  Nervo-Vascular  System. 

Part  I. — The  Nerves.      Part  II. — The  Arteries. 
Part  III. — The  Veins. 

A  New  Edition,  Revised  and  Perfected.  Arranged  by  "W.  Henry  Pkioe, 
M.D.,  and  S.  Potts  Eagleton,  M.D.  Endorsed  by  leading  anatomists.  Clearly 
and  beautifully  printed  upon  extra  durable  paper. 

PART  I.  The  Nerves. — Gives  in  a  clear  form  not  only  the  Cranial  and  Spinal  Nerves,  show- 
ing the  formation  of  the  different  Plexuses  and  their  branches,  but  also  the  complete 
distribution  of  the  Sympathetic  Nerves. 

PART  II.  The  Arteries. — Gives  a  unique  grouping  of  the  Arterial  system,  showing  the 
divisions  and  subdivisions  of  all  th6  vessels,  beginning  from  the  heart  and  tracing  their 
continuous  distribution  to  the  periphery,  and  showing  at  a  glance  the  terminal 
branches  of  each  artery. 

PART  III.  The  Veins — Shows  how  the  blood  from  the  periphery  of  the  body  is  gradually 
collected  by  the  larger  veins,  and  these  coalescing  forming  still  larger  vessels,  until  they 
finally  trace  themselves  into  the  Right  Auricle  of  the  heart. 

It  is  therefore  readily  seen  that  "The  Nervo-Vascular  System  of  Charts", 
offers  the  following  superior  advantages  : — 

1.  It  is  the  only  arrangement  which  combines  the  Three  Systems,  and  yet 
each  is  perfect  and  distinct  in  itself. 

2.  It  is  the  only  instance  of  the  Cranial,  Spinal,  and  Sympathetic  Nervous 
Systems  being  represented  on  one  chart. 

8.  From  its  neat  size  and  clear  type,  and  being  printed  only  upon  one  side, 
it  may  be  tacked  up  in  any  convenient  place,  and  is  always  ready  for  freshening 
up  the  memory  and  reviewing  for  examination. 

Price,  post-paid,  in  United  States  and  Canada,  50  cents,  net,  complete ;  in 
Great  Britain,  3s.  6d. ;  in  France,  3  fr.  60. 


For  the  student  of  anatomy  there  can  pos- 
sibly be  no  more  concise  way  of  acquiring  a 
knowledge  of  the  nerves,  veins,  and  arteries 
of  the  human  system.  It  presents  at  a  glance 
their  trunks  and  branches  in  the  great  divis- 
ions of  the  body.  It  will  save  a  world  of  tedi- 
ous reading,  and  will  impress  itself  on  the 
mind  as  no  ordinary  vade  mecum,  even,  could. 


Its  price  is  nominal  and  its  value  inestimable. 
No  student  should  be  without  it. — Pacific 
Hecord  of  Medicine  and  Surgery. 

These  are  three  admirably  arranged  charts 
for  the  use  of  students,  to  assist  in  memor- 
izing their  anatomical  sudies. — Buffalo  Med. 
and  Surg.  Jour. 


-PUBDY 

Diabetes:  Its  Cause, Symptoms  a£d Treatment 

By  Chas.  ~W.  Purdy,  M.D.  (Queen's  University),  Honorary  Fellow  of  the 
Royal  College  of  Physicians  and  Surgeons  of  Kingston  ;  Member  of  the  College 
of  Physicians  and  Surgeons  of  Ontario  ;  Author  of  "Bright's  Disease  and  Allied 
Affections  of  the  Kidneys  ;"  Member  of  the  Association  of  American  Physicians  ; 
Member  of  the  American  Medical  Association  ;  Member  of  the  Chicago  Academy 
of  Sciences,  etc. 

Contents. — Section  I.  Historical,  Geographical,  and  Climatological  Con- 
siderations of  Diabetes  Mellitus.  II.  Physiological  and  Pathological  Considera- 
tions of  Diabetes  Mellitus  III.  Etiology  of  Diabetes  Mellitus.  IV.  Morbid 
Anatomy  of  Diabetes  Mellitus.  V.  Symptomatology  of  Diabetes  Mellitus.  VI. 
Treatment  of  Diabetes  Mellitus.  VII.  Clinical  Illustrations  of  Diabetes  Mellitus. 
VIII.  Diabetes  Insipidus  ;  Bibliography. 

12mo.  Dark  Blue  Extra  Cloth.  Nearly  200  pages.  With  Clinical  Illus- 
trations.    No.  8  in  the  Physicians'  and  Students'  Ready -Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.25,  net;  in  Great 
Britain,  6s.  6d. ;  in  France,  7  fr.  75. 

lished  which  have  dealt  with  the  subject  of 
diabetes,  we  know  of  none  which  so  thoroughly 
considers  its  relations  to  the  geographical 
conditions  which  exist  in  the  United  States. 
nor  which  is  more  complete  in  its  summary  of 
the  symptomatology  and  treatment  of  this 
affection.  A  number  of  tables,  showing  the 
percentage  of  sugar  in  a  very  large  number  of 
alcoholic  beverages,  adds  very  considerably  to 
the  value  of  the  work. — Medical  News. 


This  will  prove  a  most  entertaining  as  well 
as  most  interesting  treatise  upon  a  disease 
which  frequently  falls  to  the  lot  of  every 
practitioner.  The  work  has  been  written  with 
a  special  view  of  bringing  out  the  features  of 
the  disease  as  it  occurs  in  the  United  States. 
The  author  has  very  judiciously  arranged  the 
little  volume,  and  it  will  offer  inany  pleasant 
attractions  to  the  practitioner.— Nashville 
Journal  of  Medicine  and  Surgery. 

While  many  monographs  have  been  pub- 


(17) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


HEMONJDINO 


Circumcision :  Its  History,  Modes  of 

Ion,  Etc. 


From  the  Earliest  Times  to  the  Present;  with  a  History  op 
Eunuchism,  Hermaphrodism,  etc.,  as  Observed  Among  all  Races 
and  Nations;  also  a  Description  op  the  Different  Operative 
Methods  op  Modern  Surgery  Practiced  upon  the  Prepuce. 

By  P.  C.  Remondino,  M.D.  (Jefferson)  ;  Member  of  the  American  Medical 
Association;  Member  of  the  American  Public  Health  Association;  Vice-President 
of  the  State  Medical  Society  of  California,  and  of  the  Southern  California  Medical 
Society,  etc.,  etc. 

No.  11  in  the  Physicians'  and  Students'  Ready -Reference  Series.  About  850 
pages.     12mo.     Handsomely  bound  in  Dark-Blue  Cloth.     Just  Ready. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.25,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  7  fr.  75.  Cheap  Edition  (paper  binding), 
United  States  and  Canada,  50  cents,  net,  post-paid;  Great  Britain, 
4s.  3d. ;  France,  i  fr.  20. 


ROHE 

Text-Book  of 


lene. 


A  Comprehensive  Treatise  on  the  Principles  and  Practice  of  Pre- 
ventive Medicine  from  an  American  Stand-point. 

By  George  H.  Rohe,  M.D.,  Professor  of  Obstetrics  and  Hygiene  in  the 
College  of  Physicians  and  Surgeons,  Baltimore  ;  Member  of  the  American  Public 
Health  Association,  etc. 

Every  Sanitarian  should  have  Robe's  "Text-Book  of  Hygiene  "  as  a  work 
of  reference.  Of  this  New  (second)  edition,  one  of  the  best  qualified  judges, 
namely,  Albert  L.  Gihon,  M.D.,  Medical  Director,  TJ.  S.  Navy,  in  charge  of  U.  S. 
Naval  Hospital,  Brooklyn,  N.  Y.,  and  ex-President  of  the  American  Public 
Health  Association,  writes  :  "It  is  the  most  admirable,  concise  resume  of  the  facts 
of  Hygiene  with  which  I  am  acquainted.  Prof.  Robe's  attractive  style  makes 
the  book  so  readable  that  no  better  presentation  of  the  important  place  of  Pre- 
ventive Medicine,  among  their  studies,  can  be  desired  for  the  younger  members, 
especially,  of  our  profession. 

Second  Edition,  thoroughly  revised  and  largely  rewritten,  with  many 
illustrations  and  valuable  tables.  In  one  handsome  Royal  Octavo  volume  of 
over  400  pages,  bound  in  Extra  Cloth. 

Price,  post-paid,  in  United  States,  $2.50,  net;  Canada  (duty  paid),  $2.75, 
net ;  Great  Britain,  14s. ;  France,  16  fr.  20. 


In  short,  the  work  contains  brief  and  prac- 
tical articles  on  hygienic  regulation  of  life, 
under  almost  all  conditions.  One  prominent 
feature  is  that  there  are  no  superfluous  words  ; 
every  sentence  is  direct  to  the  point  sought. 
It  is,  therefore,  easy  reading,  and  conveys  very 
much  information  in  little  space. — The  Pacific 
Record  of  Medicine  and  Surgery. 

Truly  a  most  excellent  and  valuable  work, 
comprising  the  accepted  facts  in  regard  to 
preventive  medicine,  clearly  stated  and  well 
arranged.  It  is  unquestionably  a  work  that 
should  be  in  the  hands  of  every  physician  in 
the  country,  and  medical  students  will  find  it 
a  most  excellent  and  valuable  text-book. — The 
Southern  Practitioner. 

The  first  edition  was  rapidly  exhausted,  and 
the  book  justly  became  an  authority  to  physi- 
cians and  sanitary  officers,  and  a  text-book  very 
generally  adopted  in  the  colleges  throughout 
America.  The  second  edition  is  a  great  improve- 
ment over  the  first,  all  of  the  matter  being  thor- 


oughly revised,  much  of  it  being  rewritten, 
and  many  additions  being  made.  The  size  of 
the  book  is  increased  one  hundred  pages. 
The  book  has  the  original  recommendation  of 
being  a  handsomely-bound,  clearly-printed 
octavo  volume,  profusely  illustrated  with  re- 
liable references  for  every  branch  of  the 
subject  matter. — Medical  Record. 

The  wonder  is  how  Prof.  Rohe  has  made  the 
book  so  readable  and  entertaining  with  so 
much  matter  necessarily  condensed.  The 
book  is  well  printed  with  good,  clear  type,  is 
attractive  in  appearance,  and  contains  a 
number  of  valuable  tables  and  illustrations 
tliat  must  be  of  decided  aid  to  the  student,  if 
not  to  the  general  practitioner  and  health 
officer.  Altogether,  the  manual  is  a  good  ex- 
ponent of  hygiene  and  sanitary  science  from 
the  present  American  stand-point,  and  will 
repay  with  pleasure  and  profit  any  time  that 
may  be  given  to  its  pepusal,—  University  Medi* 
cal  Magazine. 


(18) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


HAY  FEVER 


S  A  JO  US 

And  Its  Successful  Treatment  toy  Superficial 

Organic  Alteration   of  the  Masai 

Mucous    Membrane. 

By  Charles  E.  Sajous,  M.D.,  formerly  Lecturer  on  Rhinology  and 
Laryngology  in  Jefferson  Medical  College;  Vice-President  of  the  American 
Laryngological  Association;  Officer  of  the  Academy  of  France  and  of  Public 
Instruction  of  Venezuela  ;  Corresponding  Member  of  the  Royal  Society  of 
Belgium,  of  the  Medical  Society  of  Warsaw  (Poland),  and  of  the  Society  of 
Hygiene  of  France;  Member  of  the  American  Philosophical  Society,  etc.,  etc. 

With  13  Engravings  on  Wood.  103  pages.  12mo.  Bound  in  Cloth. 
Beveled  Edges. 

Price,  post-paid,  in  the 'United  States  and  Canada,  $1.00,  net;  in  Great 
Britain,  6s.;  France,  6  fr.  20. 


SAJXNE 


Diphtheria,  Croup:  Tracheotomy  and 


From  the  French  of  A.  Sanne. 

Translated  and  enlarged  by  Henry  Z.  Gill,  M  D.,  LL.D.,  late  Pro- 
fessor of  Surgery  in  Cleveland,  Ohio. 

Sanne's  work  is.  quoted,  directly  or  indirectly;  by  every  writer  since 
its  publication,  as  the  highest  authority,  statistically,  theoretically,  and 
practically.  The  translator,  having  given  special  study  to  the  subject 
for  many  years,  has  added  over  fifty  pages,  including  the  Surgical 
Anatoli^,  Intubation,  and  the  recent  progress  in  other  branches,  making- 
it,  beyond  question,  the  most  complete  work  extant  on  the  subject  of 
Diphtheria  in  the  English  language. 

Facing  the  title-page  is  found  a  very  fine  Colored  Lithograph  Plate 
of  the  parts  concerned  in  Tracheotomy.  Next  follows  an  illustration 
of  a  cast  of  the  entire  Trachea,  and  bronchi  to  the  third  or  fourth 
division,  in  one  piece,  taken  from  a  photograph  of  a  case  in  which  the 
cast  was  expelled  during  life  from  a  patient  sixteen  years  old.  This  is 
the  most  complete  cast  of  any  one  recorded. 

Over  fifty  other  illustrations  of  the  surgical  anatomy  of  instruments, 
etc.,  add  to  the  practical  value  of  the  work. 

A  full  Index  accompanies  the  enlarged  volume,  also  a  List  of 
Authors,  making  altogether  a  very  handsome  illustrated  volume  of 
over  680  pages. 


Price,  post-paid,  Cloth,   - 
Leather, 


Canada 

United  States.        (duty  paid).  Great  Britain.  France.    * 

$4.00,  Net     $4.40,  Net     22s.  6d.  24  fr.  60 

5.00,  "         5.50,  "        28s.  30  fr.  30 


The  subject  of  intubation,  so  recently  re- 
vived in  this  country,  receives  a  very  care- 
ful and  impartial  discussion  at  the  hands 
of  the  translator,  and  a  most  valuable  chapter 
on  the  prophylaxis  of  diphtheria  and  croup 
closes  the  volume.  Altogether  the  book  is 
one  that  is  valuable  and  timely,  and  one  that 
should  be  in  the  hands  of  every  general  prac- 


titioner.— St.  Louis  Med.  and  Surgical  Journ. 
Diphtheria  having  become  such  a  prevalent, 
wide-spread,  and  fatal  disease,  no  general 
practitioner  can  afford  to  be  without  this 
work.  It  will  aid  in  preventive  measures, 
stimulate  promptness  in  application  of,  and 
efficiency  in,  treatment. — Southern  Practi- 
tioner. 


(19) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


Principles  of  Surgery. 

By  N.  Senn,  M.D.,  Ph.D.,  Professor  of  Practice  of  Surgery  and  Clinical 
Surgery  in  Rush  Medical  College,  Chicago,  111.;  Professor  of  Surgery  in  the 
Chicago  Polyclinic;  Attending  Surgeon  to  the  Milwaukee  Hospital ;  "Consulting 
Surgeon  to  the  Milwaukee  County  Hospital  and  to  the  Milwaukee  County 
Insane  Asylum. 

This  work,  by  one  of  America's  greatest  surgeons,  is  thoroughly  complete; 
its  clearness  and  brevity  of  statement  are  among  its  conspicuous  merits.  The 
author's  long,  able,  and  conscientious  researches  in  every  direction  in  this 
important  field  are  a  guarantee,  of  unusual  trustworthiness,  that  every  branch  of 
the  subject  is  treated  authoritatively  and  in  such  a  manner  as  to  bring  the 
greatest  gain  in  knowledge  to  the  Practitioner  and  Student. 

In  one  handsome  Royal  Octavo  volume,  with  109  fine  Wood-Engravings 
and  624  pages. 

United  States.  Canada  (duty  paid)    Great  Britain.  France. 

Price  in  Cloth,  $1.50,  Net        $5.00,  Net        24s.  61         27  fr.  20 

"         Sheep  or  ^-Russia,    5.50    "  6.10    "         30s.  33  fr.  10 


OPINIONS    AND    CRITICISMS. 


Stephen  Smith,  M.D.,  Professor  of  Clini- 
cal Surgery  Medical  Department  University 
of  the  City  of  New  York,  writes : — "I  have 
examined  the  work  with  great  satisfaction, 
and  regard  it  as  a  most  valuable  addition  to 
American  Surgical  literature.  There  has  long 
been  great  need  of  a  work  on  the  principles  of 
surgery  which  would  fully  illustrate  the  pres- 
ent advanced  state  of  knowledge  of  the  various 
subjects  embraced  in  this  volume.  The  work 
seems  to  me  to  meet  this  want  admirably." 

Lewis  A.  Sayre,  M.D.,  Professor  Ortho- 
paedic Surgery  Bellevue  Hospital  Medical 
College,  New  York,  writes :— "  My  Dear  Doctor 
Senn  :  i'our  very  valuable  work  on  surgery, 
sent  to  me  some  time  since,  I  have  studied 
with  great  satisfaction  and  improvement.  I 
congratulate  you  most  heartily  on  having 
produced  the  most  classical  and  practical 
work  on  surgery  yet  published." 

Frank  J.  Ltjtz,  M.D.,  St.  Louis,  Mo.,  says  : 
— "It  seems  incredible  that  those  who  pretend 
to  teach  have  done  without  such  a  guide 
before,  and  I  do  not  understand  how  our  stu- 
dents succeeded  in  mastering  the  principles 
of  modern  surgery  by  attempting  to  read  our 
obsolete  text-books.  American  surgery  should 
feel  proud  of  the  production,  and  the  present 
generation  of  surgeons  owe  you  a  debt  of 
gratitude." 

W.  W.  Dawson,  M.D.,  Cincinnati,  Ohio, 
writes  : — "It  is  a  work  of  great  merit,  and  one 
greatly  needed.  Reliable  Surgery  must  be 
founded  upon  correct  principles." 

Wsr.  Ost.er,  M.D.,  The  Johns  Hopkins 
Hospital,  Baltimore,  says:— "You  certainly 
have  covered  the  ground  thoroughly  and  weli, 
and  with  a  thoroughness  I  do  not  know  of  in 
any  similar  work.  I  should  think  it  would 
prove  a  great  boon  to  the  students  and  also  to 
very  many  teachers." 

J.  C.Warren,  M.D.,  Boston,  Mass.,  writes  : 
— "  The  book  comes  at  an  opportune  moment ; 
the  old  text-books  on  Surgical  Pathology  are 
out  of  date,  and  you  are  filling  practically  a 
new  field." 

The  work  is  systematic  and  compact,  with- 
out a  fact  omitted  or  a  sentence  too  much, 
and  it  not  only  makes  instructive  but  fasci- 
nating; reading.  A  conspicuous  merit  of  Senn's 
work  is  bis  method,  his  persistent  and  tireless 
search  through  original  investigations  for 
additions  to  knowledge,  and  the  practical 
character  of  his  discoveries.  This  combina- 
tion of  the  discoverer  and  the  practical  man 
gives  a  special  value  to  all  his  work,  and  is 


one  of  the  secrets  of  his  fame.  No  physician 
in  any  line  of  practice  can  afford  to  be  without 
Serin's'  "Principles  of  Surgery." — The  Review 
of  Insanity  and  Nervous  Diseases. 

Every  chapter  is  a  mine  of  information 
containing  all  the  recent  advances  on  the  sub- 
jects presented  in  such  a  systematic,  instruc- 
tive and  entertaining  style  that  the  reader 
will  not  willingly  lay  it  aside,  but  will  read 
and  re-read  with  pleasure  and  profit. — Kansas 
Medical  Journal. 

It  is  a  most  admirable  work  in  all  respects, 
and  should  be  in  the  hands  of  every  senior 
student,  general  practitioner,  and  special 
surgeon. — Canadian  Practitioner. 

After  perusing  this  work  on  several  differ- 
ent occasions  we  have  come  to  the  conclusion 
that  it  is  a  remarkable  work  by  a  man  of  un- 
usual ability.  We  have  never  seen  anything 
like  it  before.  The  author  seems  to  have  had 
a  very  large  personal  experience,  which  is 
freely  made  use  of  in  the  text,  besides  which 
he  is  familiar  with  almost  all  that  has  been 
written  in  English  and  German  on  the  above 
topics.  We  congratulate  Dr.  Senn  upon  the 
manner  in  which  he  has  accomplished  his 
task. — The  Canada  Medical  Record. 

The  work  is  exceedingly  practical,  as  the 
chapters  on  the  treatment  of  the  various  con- 
ditions considered  are  based  on  sound  deduc- 
tions, are  complete,  and  easily  carried  out  by 
any  painstaking  surgeon.  Asepsis  and  anti- 
sepsis are  exhaustively  treated.  All  in  all,  the 
book  is  a  most  excellent  one,  and  deserves  a 
place  in  every  well-selected  library. — Medical 
Record. 

It  will  prove  exceedingly  valuable  in  the 
diffusion  of  more  thorough  knowledge  of  the 
subject-matter  among  English-speaking  sur- 
geons. As  in  the  case  of  all  his  work,  he  has 
done  this  in  a  truly  admirable  manner.  No- 
where is  there  room  to  criticise  the  accuracy 
of  Senn's  statements,  and  everywhere  is  there 
evidence  of  a  thorough  study  of  the  best 
work  of  the  most  eminent  men.  The  book 
throughout  is  worthy  of  the  highest  praise. 
It  should  be  adopted  as  a  text-book  in  all  of 
our  schools. —  University  Medical  Magazine. 

The  principles  of  surgery,  as  expounded  by 
Dr.  Senn,  are  such  as  to  place  the  student  in 
the  independent  position  of  evolving  from 
them  methods  of  treatment ;  the  master  of 
the  principles  readily  becomes  equally  a 
master  of  practice.  And  this,  of  course,  is 
really  the  whole  purpose  of  the  volume. — 
Weekly  Medical  Review.  ^ 


(20) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


SJXOEMAItMR 

Heredity,  Health,  and  Personal  Beauty. 

Including  the  Selection  of  the  Best  Cosmetics  for  the  Skin,  Hatr 
Nails,  and  all  Tarts  Relating  to  the  Body. 

By  John  V.  Shoemaker,  A.M.,  M.D.,  Professor  of  Materia  Mertica,  Phar- 
macology, Therapeutics,  and  Clinical  Medicine,  and  Clinical  Professor  of  Diseases 
of  the  Skin  in  the  Medico-Chirurgical  College  of  Philadelphia;  Physician  to  the 
Medico-Chirurgical  Hospital,  etc.,  etc. 

The  health  of  the  skin  and  hair,  and  how  to  promote  them,  are  discussed; 
the  treatment  of  the  nails;  the  subjects  of  ventilation,  food,  clothing,  warmth, * 
bathing;  the  circulation  of  the  blood,  digestion,  ventilation;  in  fact,  all  that  in 
daily  life  conduces  to  the  well-being  of  the  body  and  refinement  is  duly  enlarged 
upon.  To  these  stores  of  popular  information  is  added  a  list  of  the  best  medicated 
soaps  and  toilet  soaps,  and  a  whole  chapter  of  the  work  is  devoted  to  household 
remedies.  The  work  is  largely  suggestive,  and  gives  wise  and  timely  advice  as 
to  when  a  physician  should  be  consulted.  This  is  just  the  book  to  place  on  the  ~ 
waiting-room  table  of  every  physician,  and  a  work  that  will  prove  useful  in  the  hands 
of  your  patients. 

Complete  in  one  handsome  Royal  Octavo  volume  of  425  pages,  beautifully 
and  clearly  printed,  and  bound  in  Extra  Cloth,  Beveled  Edges,  with  side  and 
back  gilt  stamps  and  in  Half-Morocco  Gilt  Top. 

Price,  in  United  States,  post-paid,  Cloth,  $2,50;  Half-Morocco,  $3.50, 
net.  Canada  (duty  paid),  Cloth,  $2.75;  Half-Morocco,  $3.90,  net. 
Great  Britain,  Cloth,  14s. ;  Half-Morocco,  19s.  6d.  France,  Cloth, 
15  fr. ;  Half-Morocco,  22  fr. 


The  book  reads  not  like  the  fulfillment  of  a 
task,  but  like  the  researches  and  observations 
of  one  thoroughly  in  love  with  his  subject, 
fully  appreciating  its  importance,  and  writing 
for  the  pleasure  he  experiences  in  it.  The 
work  is  very  comprehensive  arid  complete  in 
its  scope. — Medical  World. 

The  book  before  us  is  a  most  remarkable 
production  and  a  most  entertaining  one.  The 
book  is  equally  well  adapted  for  the  laity  or 
the  profession.  It  tells  us  how  to  be  healthy,- 
happy,  and  as  beautiful  as  possible.  We  can't 
review  this  book ;  it  is  different  from  anything 
we  have  ever  read.  It  runs  like  a  novel,  and 
will  be  perused  until  finished  with  pleasure 
and  profit.    Buy  it,  read  it,  and  be  surprised, 


pleased,  and  improved. — The  Southern  Clinic. 

This  book  is  written  primarily  for  the  laity, 
but  will  prove  of  interest  to  the  physician  as 
well.  Though  the  author  goes  to  some  extent 
into  technicalities,  he  confines  himself  to  the 
use  of  good,  plain  English,  and  in  that  respect 
sets  a  notable  example  to  many  other  writers 
on  similar  subjects.  Furthermore,  the  book 
is  written  from  a  thoroughly  American  stand- 
point.— Medical  Record. 

This  is  an  exceedingly  interesting  book, 
both  scientific  and  practical  in  character,  in- 
tended for  both  professional  and  lay  readers. 
The  book  is  well  written  and  presented  in  ad- 
mirable form  by  the  publisher. — Canadian 
Practitioner. 


SHOEMAKMB 

Ointments  and  Olcatcs  :  Espe<^f£e  swn!ease9 

By  John  V.  Shoemaker,  A.M.,  M.D.,  Professor  of  Materia  Medica,  Phar- 
macology, Therapeutics,  and  Clinical  Medicine,  and  Clinical  Professor  of  Diseases 
of  the  Skin  in  the  Medico-Chirurgical  College  of  Philadelphia,  etc.,  etc. 

The  author  concisely  concludes  his  preface  as  follows:  "The  reader  may 
thus  obtain  a  conspectus  of  the  whole  subject  of  inunction  as  it  exists  to-day  in 
the  civilized  world.  In  all  cases  the  mode  of  preparation  is  given,  and  the  thera- 
peutical application  described  seriatim,  in  so  far  as  may  be  clone  without  needless 
repetition." 

Second  Edition,  revised  and  enlarged.  298  pages.  12mo.  Neatly  bound 
in  Dark-Blue  Cloth.    No.  6  in  the  Physicians'  and  Students'  Beady -Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  fr.  35. 


It  is  invaluable  as  a  ready  reference  when 
ointments  or  oleates  are  to  be  used,  and  is 
serviceable  to  both  druggist  and  physician. — 
Canada  Medical  Record. 

To  the  physician  who  feels  uncertain  as  to 


the  best  form  in  which  to  prescribe  medicines 
by  way  of  the  skin  the  book  will  prove  valu- 
able, owing  to  the  many  prescriptions  and 
formula  which  dot  its  pages,  while  the  copious 
index  at  the  back  materially  aids  in  making 
the  book  a  useful  one.— Medical  News. 


(21) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
SHOEMAKER 

ica  and  Therapeutics. 


With  Especial  Reference  to  the  Clinical  Application  of  Drugs. 
Being  the  Second  and  Last  Volume  of  a  Treatise  on  Materia 
Medica,  Pharmacology,  and  Therapeutics,  and  an  Independent 
Volume  upon  Drugs. 

By  John  V.  Shoemaker,  A.M.,  M.D.,  Professor  of  Materia  Medica, 
Pharmacology,  Therapeutics,  and  Clinical  Medicine,  and  Clinical  Professor  of 
Diseases  of  the  Skin  in  the  Medico-Chirurgical  College  of  Philadelphia;  Physician 
to  the  Medico-Chirurgical  Hospital,  etc.,  etc. 

This,  the  second  volume  of  Shoemaker's  "Materia  Medica,  Pharmacology, 
and  Therapeutics,"  is  wholly  taken  up  -with  the  consideration  of  drugs,  each 
remedy  heing  studied  from  three  points  of  view,  viz. :  the  Preparations,  or  Materia 
Medica;  the  Physiology  and  Toxicology,  or  Pharmacology;  and,  lastly,  its 
Therapy.  It  is  thoroughly  ahreast  of  the  progress  of  Therapeutic  Science,  and 
is  really  an  indispensable  book  to  every  student  and  practitioner  of  medicine. 

Royal  Octavo,  about  675  pages.     Thoroughly  and  carefully  indexed. 

Price,   in  "United  States,  post-paid,  Cloth,  $3.50;   Sheep,  $4.50,  net. 
Canada  (duty  paid),  Cloth,  $4.00;   Sheep,  $5.00,  net.     Great  Brit- 
ain, Cloth,  20s. ;   Sheep,  26s.     France,  Cloth,  22  fr.   40;   Sheep, 
28  fr.  60. 
The  first  volume  of  this  work  is  devoted  to  Pharmacy,  General  Pharma- 
cology, and  Therapeutics,  and  remedial  agents  not  properly  classed  with  drugs. 
Royal  Octavo,  353  pages. 

Price  of  Volume  I,  post-paid,  in  United  States,  Cloth,  $2.50,  net;  Sheep, 
$3.25,  net.  Canada,  duty  paid,  Cloth,  $2.75,  net;  Sheep,  $3.60,  net. 
Great  Britain,  Cloth,  14s. ;  Sheep,  18s.  France,  Cloth,  16  fr.  20 ; 
Sheep,  20  fr.  20.    The  volumes  are  sold  separately. 

SHOEMAKER'S  TREATISE  ON  MATERIA  MEDICA,  PHARMACOLOGY,  AND  THERA- 
PEUTICS STANDS  ALONE. 

(1)     Among  Materia  Medica  text-books,  in  that  it  includes  every  officinal  drug  and  every 

preparation  contained  in  the  United  States  Pharmacopoeia. 
(3)    In  that  it  is  the  only  work  on  therapeutics  giving  the  strength,  composition,  and  dosage 

of  every  officinal  preparation. 

(3)  In  giving  the  latest  investigations  with  regard  to  the  physiological  action  of  drugs  and 

the  most  recent  applications  in  therapeutics.  * 

(4)  In  combining  with  officinal  drugs  the  most  reliable  reports  of  the  actions  and  uses  of  all 

the  noteworthy  new  remedies,  such  as  acetanilid,  antipyrin,  bromoform,  exalgin,  pyok- 
tanin,  pyridin,  soninal,  spermine  (Brown-Sequard),  tuberculin  (Koch's lymph),  sulphonal, 
thiol,  urethan,  etc.,  etc. 

(5)  As  a  complete  encyclopaedia  of  modern  therapeutics  in  condensed  form,  arranged  alpha- 

betically for  convenience  of  reference  for  either  physician,  dentist,  or  pharmacist,  when 
immediate  information  is  wanted  concerning  the  action,  composition,  dose,  or  antidotes 
for  any  officinal  preparation  or  new  remedy. 

(6)  In  giving  the  physical  characters  and  chemical  formulae  of  the  new  remedies,  especially 

the  recently-introduced  antipyretics  and  analgesics. 
(T)    In  the  fact  that  it  gives  special  attention  to  the  consideration  of  the  diagnosis  and  treat- 
ment of  poisoning  by  the  more  active  drugs,  both  officinal  and  non-officinal. 

(8)  And  unrivaled  in  the  number  and  variety  of  the  prescriptions  and  practical  formulae, 

representing  the  latest  achievements  of  clinical  medicine. 

(9)  In  that,  while  summarizing  foreign  therapeutical  literature,  it  fully  recognizes  the  work 

done  in  this  department  by  American  physicians.  It  is  an  epitome  of  the  present  state 
of  American  medical  practice,  which  is  universally  acknowledged  to  be  the  best  practice. 

(10)  Because  it  is  the  most  complete,  convenient,  and  compendious  work  of  reference,  being, 

in  fact,  a  companion  to  the  United  States  Pharmacopoeia,  a  drug-encyclopaedia,  and  a 
therapeutic  hand-book  all  in  one  volume. 


The  value  of  the  book  lies  in  the  fact  that 
it  contains  all  that  is  authentic  and  trust- 
worthy about  the  host  of  new  remedies  which 
have  deluged  us  in  the  last  five  years.  The 
pages  are  remarkably  free  from  useless  infor- 
mation. The  author  has  done  well  in  following 
the  alphabetical  order.— N.  Y.  Med.  Record. 

In  perusing  the  pages  devoted  to  the  special 
consideration  of  drugs,  their  pharmacology, 
physiological  action,  toxic  action,  and  therapy, 
one  is  constantly  surprised  at  the  amount  of 


material  compressed  in  so  limited  a  space. 
The  book  will  prove  a  valuable  addition  to  the 
physician  's  library. — Occidental  Med.  Times. 
It  is  a  meritorious  work,  with  many  unique 
features.  It  is  richly  illustrated  by  well-tried 
prescriptions  showing  the  practical  applica- 
tion of  the  various  drugs  discussed.  In  short, 
this  work  makes  a  pretty  complete  encyclo- 
paedia of  the  science  of  therapeutics,  conve- 
niently arranged  for  handy  reference.— Med. 
World. 


(22) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
SMITH 

Physiology  of  the  Domestic  Animals. 

A  Text-Book  for  Veterinary  and  Medical  Students  and  Practitioners. 

By  Robert  Meade  Smith,  A.M.,  M.D.,  Professor  of  Comparative  Physi- 
ology in  University  of  Pennsylvania;  Fellow  of  the  College  of  Physicians  and 
Academy  of  the  Natural  Sciences,  Philadelphia;  of  American  Physiological 
Society;  of  the  American  Society  of  Naturalists,  etc. 

This  new  and  important  work,  the  most  thoroughly  complete  in  the 
English  language  on  this  subject,  treats  of  the  physiology  of  the  domestic  animals 
in  a  most  comprehensive  manner,  especial  prominence  being  given  to  the  subject 
of  foods  and  fodders,  and  the  character  of  the  diet  for  the  herbivora  under 
different  conditions,  with  a  full  consideration  of  their  digestive  peculiarities. 
Without  being  overburdened  with  details,  it  forms  a  complete  text-book  of 
physiology  adapted  to  the  use  of  students  and  practitioners  of  both  veterinary 
and  human  medicine.  This  work  has  already  been  adopted  as  the  Text-Book  on 
Physiology  in  the  Veterinary  Colleges  of  the  United  States,  Great  Britain,  and 
Canada.  In  one  Handsome  Royal  Octavo  Volume  of  over  950  pages,  profusely" 
illustrated  with  more  than  400  Pine  Wood-Engravings  and  many  Colored  Plates. 


Price,  Cloth, 
"      Sheep, 


United  States. 

$5.00,  Net 
6.00    " 


Canada  (duty  paid) 

Great  Britain. 

France. 

$5.50,  Net 

28s. 

30  fr.  30 

6.60    " 

32s. 

36  fr.  20 

A.  Liatjtard,  M.D.,  H.F.R.C.,  V.S.,  Pro- 
fessor of  Anatomy,  Operative  Surgery,  and 
Sanitary  Medicine  in  the  American  Veterinary 
College,  New  York,  writes:— "I  have  exam- 
ined the  work  of  Dr.  R.  M.  Smith  on  the 
'Physiology  of  the  Domestic  Animals,'  and  con- 
sider it  one  of  the  best  additions  to  veterinary 
literature  that  we  have  had  for  some  time." 

E.  M.  Reading,  A.M.,  M.D.,  Professor  of 
Physiology  in  the  Chicago  Veterinary  College, 
writes: — "I  have  carefully  examined  the 
'Smith's  Physiology,'  published  by  you,  and 
like  it.  It  is  comprehensive,  exhaustive,  and 
complete,  and  is  especially  adapted  to  those 
who  desire  to  obtain  a  full  knowledge  of  the 
principles  of  physiology,  and  are  not  satisfied 
with  a  mere  smattering  of  the  cardinal  points." 

Dr.  Smith's  presentment  of  his  subject  is  as 
brief  as  the  status  of  the  science  permits,  and 
to  this  much-desired  conciseness  he  has  added 
an  equally  welcome  clearness  of  statement. 
The  illustrations  in  the  work  are  exceedingly 
good,  and  must  prove  a  valuable  aid  to  the 


full  understanding  of  the  text,— Journal  oj 
Comparative  Medicine  and  Surgery. 

Veterinary  practitioners  and  graduates  will 
read  it  with  pleasure.  Veterinary  students 
will  readily  acquire  needed  knowledge  from 
its  pages,  aiid  veterinary  schools,  which  would 
be  well  equipped  for  the  work  they  aim  to 
perform,  cannot  ignore  it  as  their  text-book 
in  physiology. — American  Veterinary  Review. 

Altogether,  Professor  Smith's  "  Physiology 
of  the  Domestic  Animals"  is  a  happy' produc- 
tion, and  will  be  hailed  with  delight  in  both 
the  human  medical  and  veterinary  medical 
worlds.  It  should  find  its  place,  besides,  in  all 
agricultural  libraries.— Paul  Paquin,  M.D., 
\  .S.,  in  the  Weekly  Medical  Review. 

The  author  has  judiciously  made  the  nutri- 
tive functions  the  strong  point  of  the  work, 
and  has  devoted  special  attention  to  the  sub- 
ject of  foods  and  digestion.  In  looking 
through  other  sections  of  the  work,  it  appears 
tousthatajust  proportion  of  space  is  assigned 
to  each,  in  view  of  their  relative  importance 
to  the  practitioner. — Loudon  Lancet. 


SOZINSKEY 


Medical  Symbolism, 


Historical  Studies  in  the  Arts 
of  Healing:  and  Hygiene. 

By  Thomas  S.  Sozinskey,  M.D.,  Ph.D.,  Author  of  "The  Culture  of 
Beauty,"  "The  Care  and  Culture  of  Children,"  etc. 

12mo.  Nearly  200  pages.  Neatly  bound  in  Dark -Blue  Cloth.  Appropri- 
ately illustrated  with  upward  of  thirty  (30)  new  Wood-Engravings.  No.  9  in  the 
Physicians'  and  Students'  Ready-Reference  Series. 

Price,  post-paid,  in  United  States  and  Canada,  $1.00,  net;  Great 
Britain,  6s. ;  France,  6  fr.  20. 

He  who  has  not  time  to  more  fully  study  the 
more  extended  records  of  the  past,  will  highly 
prize  this  little  book.  Its  interesting  discourse 
upon  the  past  is  full  of  suggestive  thought.— 
American  Lancet. 

Like  an  oasis  in  a  dry  and  dusty  desert  of 
medical  literature,  through  which  we  wearily 
stagger,  is  this  work  devoted  to  medical  sym- 
bolism and  mythology.  As  the  author  aptly 
quotes:  "What  same  light  braines  may  esteem 
as  foolish  toyes,  deeper  judgments  can  and 


will  value  as  sound  and  serious  matter."— Can- 
adian Practitioner. 

In  the  volume  before  us  we  have  an  admira- 
ble and  successful  attempt  to  set  forth  hi 
order  those  medical  symbols  which  have  come 
down  to  us.  and  to  explain  on  historical  grounds 
their  significance.  An  astonishing  amount  of 
information  is  contained  within  the  covers  of 
the  book,  and  every  page  of  the  work  bears 
token  of  the  painstaking  genius  and  erudite 
mind  of  the  now  unhappily  deceased  author. 
—London  Lancet. 


(23) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


STEWART 


Obstetric  Synopsis. 


By  John  S.  Stewart,  M.D.,  formerly  Demonstrator  of  Obstetrics  and 
Chief  Assistant  in  the  Gynaecological  Clinic  of  the  Medico-Chirurgical  College 
of  Philadelphia:  with  an  introductory  note  by  William  S.  Stewart,  A.M., 
M.D.,  Professor  of  Obstetrics  and  Gynaecology  in  the  Medico-Chirurgical  College 
of  Philadelphia. 

By  students  this  work  will  be  found  particularly  useful.  It  is  based  upon 
the  teachings  of  such  well-known  authors  as  Playfair,  Parvin,  Lusk,  Galabin, 
and  Cazeaux  and  Tarnier,  and  contains  much  new  and  important  matter  of  great 
value  to  both  student  and  practitioner. 

With  42  Illustrations.  202  pages.  12mo.  Handsomely  bound  in  Dark- 
Blue  Cloth.     No.  1  in  the  Physicians'  and  Students'  Ready -Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net;  in  Great 
Britain,  6s.;  France,  S  fr.  20. 


DeLaskie  Miller,  M.D.,  Professor  of 
Obstetrics,  Rush  Medical  College,  Chicago, 
111.,  says: — "I  have  examined  the  'Obstetric 
Synopsis,'  by  John  S.  Stewart,  M.D.,  and  it 
gives  me  pleasure  to  characterize  the  work  as 
systematic,  concise,  perspicuous,  and  authen- 
tic.   Among  manuals  it  is  one  of  the  best." 

It  is  well  written,  excellently  illustrated, 
and  fully  up  to  date  in  every  respect.  Here 
we  rind  all  the  essentials  of  Obstetrics  in  a 
nutshell,  Anatomy,  Embryology,  Physiology, 
Pregnaucy,  Labor,  Puerperal  State, "and  Ob- 
stetric Operations  all  being  carefully  and  ac- 


curately described. — Buffalo  Medical  and 
Surgical  Journal. 

It  is  clear  and  concise.  The  chapter  on  the 
development  of  the  ovum  is  especially  satis- 
factory. The  judicious  use  of  bold-faced 
type  for  headings  and  italics  for  important 
statements  gives  the  book  a  pleasing  typo- 
graphical appearance. — Medical  Record. 

This  volume  is  done  with  a  masterly  hand. 
The  scheme  is  an  excellent  one.  The  whole 
is  freely  and  most  admirably  illustrated  with 
well-drawn,  new  engravings,  and  the  book  is 
of  a  very  convenient  size. — St.  Louis  Medical 
and  Surgical  Journal. 


ULTZ3IAWW 

The  Neuroses  of  the  Genito-Urinary  System 

in  the  Male. 

With  Sterility  and  Impotence. 

By  Dr.  B.  TJltzmann,  Professor  of  Genito-Urinary  Diseases  in  the  Uni- 
versity of  Vienna.  Translated,  with  the  author's  permission,  by  Gardner  W. 
Allen,  M.D.,  Surgeon  in  the  Genito-Urinary  Department,  Boston  Dispensary. 

Full  and  complete,  yet  terse  and  concise,  it  handles  the  subject  with  such 
a  vigor  of  touch,  such  a  clearness  of  detail  and  description,  and  such  a  directness 
to  the  result,  that  no  medical  man  who  once  takes  it  up  will  be  content  to  lay  it 
down  until  its  perusal  is  complete, — nor  will  one  reading  be  enough. 

Professor  Ultzmann  has  approached  the  subject  from  a  somewhat  different 
point  of  view  from  most  surgeons,  and  this  gives  a  peculiar  value  to  the  work. 
It  is  believed,  moreover,  that  there  is  no  convenient  hand-book  in  English  treat- 
ing in  a  broad  manner  the  Genito-Urinary  Neuroses. 

Synopsis  of  Contents. — First  Part — I.  Chemical  Changes  in  the  Urine  in 
Cases  of  Neuroses.  II.  Neuroses  of  the  Urinary  and  of  the  Sexual  Organs, 
classified  as  :  (1)  Sensory  Neuroses;  (2)  Motor  Neuroses  ;  (3)  Secretory  Neuroses. 
Second  Part — Sterility  and  Impotence.  The  treatment  in  all  cases  is  described 
clearly  and  minutely. 

Illustrated.  12mo.  Handsomely  bound  in  Dark-Blue  Cloth.  No.  4  in  the 
Physicians'  and  Students'  Ready-Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net ;  in  Great 
Britain,  6s. ;  in  France,  6  fr.  20. 


This  book  is  to  be  highly  recommended, 
owing  to  its  clearness  and  brevity.  Altogether, 
we  do  not  know  of  any  book  of  the  same  size 
which  contains  so  much  useful  information  in 
such  a  short  space. — Medical  News. 

Its  scope  is  large,  not  being  confined  to  the 
one  condition, — neurasthenia, — but  embracing 
all  of  the  neuroses,  motor  and  sensory,  of  the 
genito-urinary  organs  in  the  male.  No  one 
wlin  has  read  after  Dr.  Ultzmann  need  be  re- 


minded of  his  delightful  manner  of  presenting 
his  thoughts,  which  ever  sparkle,  with  original- 
ity and  appositeness.—  Weekly  Med.  Review. 

It  engenders  sound  pathological  teaching, 
and  will  aid  in  no  small  degree  in  throwing 
light  on  the  management  of  many  of  the  dif- 
ficult and  more  refractory  cases  of  the  classes 
to  which  these  essays  especially  refer.— The 
Medical  Age. 


(24) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 

WHEELER 

Abstracts  of  Pharmacology. 

By  H.  A.  Wheeler,  M.D.  (Registered  Pharmacist,  No.  3408,  Iowa).  Pre- 
pared for  the  use  of  Physicians  and  Pharmacists,  and  especially  for  the  use  of 
Students  of  Medicine  and  Pharmacy,  who  are  preparing  for  Examination  in 
Colleges  and  before  State  Boards  of  Examiners. 

This  book  does  not  contain  questions  and  answers,  but  solid  pages  of 
abstract  information.  It  will  he  an  almost  indispensable  companion  to  the  prac- 
ticing Pharmacist,  and  a  very  useful  reference-book  to  the  Physician.  It  contains 
a  brief  but  thorough  explanation  of  all  terms  and  processes  used  in  practical 
pharmacy,  an  abstract  of  all  that  is  essential  to  be  known  of  each  officinal  drug,. 
its  preparations  and  therapetic  action,  with  doses;  in  Chemistry  and  Botany, 
much  that  is  useful  to  the  Physician  and  Pharmacist;  a  general  working  formula 
for  each  class  and  an  abstract  formula  for  each  officinal  preparation,  and  many  of 
the  more  popular  unofficinal  ones,  together  with  their  doses;  also  many  symbolic 
formulas;  a  list  of  abbreviations  used  in  prescription  writing;  rules  governing 
incompatibilities;  a  list  of  Solvents;  tests  for  the  more  common  drugs;  the  habitat 
and  best  time  for  gathering  plants  to  secure  their  medical  properties. 

The  book  contains  i80  pages,  5|  x  8  inches,  closely  printed  and  on  the  best 
paper,  nicely  and  durably  bound,  containing  a  greater  amount  of  information  on 
the  above  topics  than  any  other  work  for  the  money. 

Price,  post-paid,  in  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  6<L ;  in  France,  9  fr.  35. 


TOUKG 

Synopsis  of  Human  Anatomy. 

Being  a  Complete  Compend  of  Anatomy,  Including  the  Anatomy  of 
the  Viscera,  and  Numerous  Tables. 

By  James  K.  Young,  M.D.,  Instructor  in  Orthopa?dic  Surgery  and  Assistant 
Demonstrator  of  Surgery,  University  of  Pennsylvania;  Attending  Orthopaedic 
Surgeon,  Out-Patient  Department,  University  Hospital,  etc. 

While  the  author  has  prepared  this  work  especially  for  students,  sufficient 
descriptive  matter  has  been  added  to  render  it  extremely  valuable  to  the  busy 
practitioner,  particularly  the  sections  on  the  Viscera,  Special  Senses,  and  Sur- 
gical Anatomy. 

The  work  includes  a  complete  account  of  Osteology,  Articulations  and 
Ligaments,  Muscles,  Fascias,  Vascular  and  Nervous  Systems,  Alimentary,  Vocal, 
and  Respiratory  and  Genito-Urinary  Apparatus,  the  Organs  of  Special  Sense, 
and  Surgical  Anatomy. 

In  addition  to  a  most  carefully  and  accurately  prepared  text,  wherever 
possible,  the  value  of  the  work  has  been  enhanced  by  tables  to  facilitate  and 
minimize  the  labor  of  students  in  acquiring  a  thorough  knowledge  of  this 
important  subject.  The  section  on  the  teeth  has  also  been  especially  prepared 
to  meet  the  requirements  of  students  of  dentistry. 

Illustrated  with  76  Wood-Engravings.  390  pages.  12mo.  No.  3  in  the 
Physicians'  and  Students'  Beady-Reference  Series. 

Price,  post-naid,  in  United  States  and  Canada  $1.10,  net; 
Great  Britain,  8s.  6d. ;  France,  9  fr.  25. 


Every  unnecessary  word  has  been  excluded, 
out  of  regard  to  the  very  limited  time  at  the 
medical  student's  disposal.  It  is  also  good  as 
a  reference-book,  as  it  presents  the  facts  about 
which  he  wishes  to  refresh  his  memory  in  the 
briefest  manner  consistent  with  clearness. — 
New  York  Medical  Journal. 

As  a  companion  to  the  dissecting-table,  and 
a  convenient  reference  for  the  practitioner,  it 


has  a  definite  field  of  usefulness.— Pittsburgh 
Medical  Review. 

The  book  is  much  more  satisfactory  than  the 
"remembrances  "  in  vogue,  and  yet  is  not  too 
cumbersome  to  be  carried  around  and  read  at 
odd  moments — a  property  which  the  student 
will  readily  appreciate.  —  Weekly  Medical 
Review. 


(25) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
WITHERSTINE 

The  International  Pocket  Medical  Formulary 

Arranged  Therapeutically. 

By  C.  Sumner  Witherstine,  M.S.,  M.D.,  Associate  Editor  of  the 
"Annual  of  the  Universal  Medical  Sciences  ;"  Visiting  Physician  of  the  Home 
for  the  Aged,  Germantown,  Philadelphia  ;  Late  House-Surgeon  Charity  Hospital, 
New  York. 

More  than  1800  formulae  from  several  hundred  well-known  authorities. 
With  an  Appendix  containing  a  Posological  Tahle,  the  newer  remedies  included  ; 
Important  Incompatibles  ;  Tables  on  Dentition  and  the  Pulse  ;  Table  of  Drops 
in  a  Fluidrachm  and  Doses  of  Laudanum  graduated  for  age  ;  Formulae  and  Doses 
of  Hypodermatic  Medication,  including  the  newer  remedies  ;  Uses  of  the  Hypo- 
dermatic Syringe  ;  Formulae  and  Doses  for  Inhalations,  Nasal  Douches,  Gargles, 
and  Eye-washes  ;  Formulae  for  Suppositories  ;  Use  of  the  Thermometer  in  Dis- 
ease ;  Poisons,  Antidotes,  and  Treatment  ;  Directions  for  Post-Mortem  and 
Medico-Legal  Examinations  ;  Treatment  of  Asphyxia,  Sun-stroke,  etc.  ;  Anti- 
emetic Remedies  and  Disinfectants  ;  Obstetrical  Table  ;  Directions  for  Ligations 
of  Arteries  ;  Urinary  Analysis  ;  Table  of  Eruptive  Fevers  ;  Motor  Points  for 
Electrical  Treatment,  etc. 

This  work,  the  best  and  most  complete  of  its  kind,  contains  about  275 
printed  pages,  besides  extra  blank  leaves — the  book  being  interleaved  throughout 
— elegantly  printed,  with  red  lines,  edges,  and  borders;  with  illustrations.  Bound 
in  leather,  with  side  flap. 

It  is  a  handy  book  of  reference,  replete  with  the  choicest  formulae  (over 
1800  in  number)  of  more  than  six  hundred  of  the  most  prominent  classical  writers 
and  modern  practitioners. 

The  remedies  given  are  not  only  those  whose  efficiency  has  stood  the  test 
of  time,  but  also  the  newest  and  latest  discoveries  in  pharmacy  and  medical 
science,  as  prescribed  and  used  by  the  best-known  American  and  foreign  modern 
authorities. 

It  contains  the  latest,  largest  (66  formulae),  and  most  complete  collection  of 
hypodermatic  formulae  (including  the  latest  new  remedies)  ever  published,  with 
doses  and  directions  for  their  use  in  over  fifty  different  diseases  and  diseased 
•  conditions. 

Its  appendix  is  brimful  of  information,  invaluable  in  office  work,  emergency 
cases,  and  the  daily  routine  of  practice. 

It  is  a  reliable  friend  to  consult  when,  in  a  perplexing  or  obstinate  case,  the 
usual  line  of  treatment  is  of  no  avail.  (A  hint  or  a  help  from  the  best  authorities, 
as  to  choice  of  remedies,  correct  dosage,  and  the  eligible,  elegant,  and  most  palat- 
able mode  of  exhibition  of  the  same.) 

It  is  compact,  elegantly  printed  and  bound,  well  illustrated,  and  of  conve- 
nient size  and  shape  for  the  pocket. 

The  alphabetical  arrangement  of  the  diseases  and  a  thumb-letter  index 
render  reference  rapid  and  easy. 

Blank  leaves,  judiciously  distributed  throughout  the  book,  afford  a  place  to 
record  and  index  favorite  formulae. 

As  a  student,  the  physician  needs  it  for  study,  collateral  reading,  and  for 
recording  the  favorite  prescriptions  of  his  professors,  in  lecture  and  clinic;  as  a 
recent  graduate,  he  needs  it  as  a  reference  hand-book  for  daily  use  in  prescribing 
(gargles,  nasal  douches,  inhalations,  eye-washes,  suppositories,  incompatibles, 
poisons,  etc.);  as  an  old  practitioner,  he  needs  it  to  refresh  his  memory  on  old 
remedies  and  combinations,  and  for  information  concerning  newer  remedies  and 
more  modern  approved  plans  of  treatment. 

No  live,  progressive  medical  man  can  afford  to  be  without  it. 

Price,  post-paid,  in  United  States  and  Canada  $2.00,  net ; 
Great  Britain,  lis.  Sd. ;  France,  12  fr.  40. 

enough  of  incompatibilities  before  commenc- 
ing practice  to  avoid  writing  incompatible  and 
dangerous  prescriptions,  'the  constant  use  of 
such  a  book  by  such  prescribers  would  save 
the  pharmacist  much  anxiety.— The  Drug- 
gists? Circular. 

In  judicious  selection,  in  accurate  nomen- 
clature, in  arrangement,  and  in  style,  it  leaves 
nothing  to  be  desired.  The  editor  and  the 
publisher  are  to  be  congratulated  on  the  pro- 
duction of  the  very  best  book  of  its  class. — 
Pittsburgh  Medical  Review. 


It  is  sometimes  important  that  such  prescrip- 
tions as  have  been  well  established  in  their 
usefulness  be  preserved  for  reference,  and 
this  little  volume  serves  such  a  purpose  better 
than  any  other  we  have  seen. — Columbus  Med- 
ical Journal. 

To  the  young  physiciun  just  starting  out  in 
practice  this  little  book  will  prove  an  accept- 
able companion. — Omaha  Clinic. 

As  long  as  "combinations"  are  sought,  such 
a  book  will  be  of  value,  especially  to  those 
who  cannot  spare  the  time  required  to  learn 


(26) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 

Annual  of  the  Universal  Medical  Sciences. 

A  Yearly  Report  of  the  Progress  of  the  General  Sanitary 
Sciences  Throughout  the  World. 

Edited  by  Charles  E.  Sajous,  M.D.,  formerly  Lecturer  on  Laryngology 
and  Rhinology  in  Jefferson  Medical  College,  Philadelphia,  etc.,  and  Seventy 
Associate  Editors,  assisted  by  over  Two  Hundred  Corresponding  Editors  and 
Collaborators.  In  Five  Royal  Octavo  Volumes  of  about  500  pages  each,  bound 
in  Cloth  and  Half-Russia,  Magnificently  Illustrated  with  Chromo-Lithographs, 
Engravings,  Maps,  Charts,  and  Diagrams.  Being  intended  to  enable  any  physi- 
cian to  possess,  at  a  moderate  cost,  a  complete  Contemporary  History  of  Universal 
Medicine,  edited  by  many  of  America's  ablest  teachers,  and  superior  in  every 
detail  of  print,  paper,  binding,  etc.,  a  befitting  continuation  of  such  great  works 
as  "Pepper's  System  of  Medicine,"  " Ashhurst's  International  Encyclopaedia  of 
Surgery,"  "Buck's  Reference  Hand-Book  of  the  Medical  Sciences." 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON   RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Subscription  Price  per  Year  (including  the  "  SATELLITE  "  for  one  year) : 
In  United  States,  Cloth,  5  vols.,  Royal  Octavo,  $15.00;  Half-Russia,  5  vols., 
Royal  Octavo,  $20.00.  Canada  (duty  paid),  Cloth,  $16  50;  Half- Russia, 
$22.00.  Great  Britain,  Cloth,  £4  7s. ;  Half-Russia,  £5  15s.  France,  Cloth, 
93  fr.  95 ;  Half-Russia,  124  fr.  35. 

The  Satellite  of  the  "Annual  of  the  Universal  Medical  Sciences."  A 
Monthly  Review  of  the  most  important  articles  upon  the  practical  branches  of 
Medicine  appearing  in  the  medical  press  at  large,  edited  by  the  Chief  Editor  of 
the  Annual  and  an  able  staff.  Published  in  connection  with  the  Annual,  and 
for  its  Subscribers  Only. 


Editorial  Staff  of  the  Annual  of  the  Universal  Medical  Sciences. 

CONTRIBUTORS  TO  SERIES  1888,  18S9,  1890,  1891. 

Editor-in-Chief,  CHARLES  E.  SAJOUS,  M.D.,  Philadelphia. 


SENIOR   ASSOCIATE    EDITORS. 

Agnew,  D.  Haves,  M.D.,  LL.D..  Philadelphia, 

series  of  1888,  1889. 
Baldy,  J.  M..  M.D.,  Philadelphia,  1891. 
Barton,   J.  M.,  A.M.,  M.D.,  Philadelphia,  1889, 

1*90,  1891. 
Birdaall,  W.  R.,  M.D.,  New  York,  1889,  1890, 

1891. 
Brown,  F.  W.,  M.D.,  Detro:t,1890,  1891. 
Bruen,  Edward T.,  M.D.,  Philadelphia,  1889. 
Brush,  Edward  N.,   M.D.,  Philadelphia,  1889, 

1890.  1891. 
Cohen.  J.  Solis,  M.D.,  Philadelphia,   1888,  1889, 

1890,  1891. 
Conner,  P.  S.,  M.D.,  LL.D.,  Cincinnati,  1888, 

1889,  1890,  1891. 

Currier,  A.   P.,  A.B.,  M.D.,  New  York,   1889, 

1890,  1891. 

Davidson,  C.  C,  M  D.,  Philadelphia,  1888. 
Davis,  N.  S.,  A.M.,  M.D.,  LL.D.,  Chicago,  1888, 

1889,  1890,  1891. 

Delafield,  Francis,  M.D.,  New  York,  1888. 
Delavan,   D.   Bryson,  M.D.,   New  York,  1888, 

1889, 1S90,  1891. 
Draper,  F.  Winthrop.  A.M.,  M.D.,  New  York, 

1888.  1889,  1890,  1891. 

Dudley,  EM  ward  C,  M.D.,  Chicago,  1888. 
Ernst.   Harold  C,   A.M.,  M.D.,  Boston,   1889, 

1890,  1891. 

Forbes,  William  S.,  M.D.,  Philadelphia,  1888, 

1889,  1890. 

Garretson,    J.   E.,   M.D.,    Philadelphia,    1888, 
1889. 


Gaston,   J.   McFadden,   M.D.,    Atlanta,    1890, 

1891. 
Gihon.  Albert  L.,  A.M.,  M.D.,  Brooklyn,  1888, 

1889.  1890.  1891. 
Gondii.  William,   M.D.,    Philadelphia,    1888, 

1889.  1890. 

Grav,  Landon  Carter,  M.D.,  NewYork,   1S90, 

1891. 
Griffith.  .T.  P.  Crozer,  M.D.,  Philadelphia,  18S9, 

1890.  1891. 

Guilford,  S.  H.,  D.D.S.,  Ph.D.,  Philadelphia, 

1888. 
Guite'ras,  John,  M.D.,  Ph,D.,  Charleston,  1888, 

1889. 
Hamilton.  John  B..  M.D.,  LL.D.,  Washington, 

1888.  1889,  1890.  1891. 

Hare.  Hobart  Aniorv.  M.D.,  B.Sc  ,  Philadel- 
phia. 1888,  1889.  1890,  1891. 

Henrv.  Frederick  P.,  M.D.,  Philadelphia,  1889. 
1890,  1891. 

Holland,  J.  W.,  M.D..  Philadelphia.  1888.  1889. 

Holt.  L.  Emmett,  M.D.,  New  York,  18S9,  1890, 
1891. 

Howell,   W.     FT..    Ph.D.,   M.D.,   Ann    Arbor, 

1889.  1890,  1891. 

Hun.  Henry,  M.D..  Albany,  1889.  1890. 
Hooper.  Franklin  H,  M.D..  Boston,  1890.  1891. 
Ingals.  E.  Fletcher,  A.M.,  M.D.,  Chicago,  1889, 

1890.  1891. 

laggard,  W.  W.,  A.M.,  M.D.,  Chicago.  1890. 
Johnston,  Christopher,  M.D.,  Baltimore,  1S88, 

1889. 
Johnston.  W.  W.,  M.D.,  Washington,  1SSS,  1889, 

1890,  1891. 


(27) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


SENIOR   ASSOCIATE    EDITORS 

(CONTINUED). 

Keating,  John  M.,  M.D.,  Philadelphia,  1889. 
Kelsev,  Charles  B.,  M.D.,  New  York,  1888, 1889, 

1890,  1891. 
Keyes,   Edward  L.,  A.M.,  M.D.,  New  York, 

1888, 1889,  1890,  1891. 
Knapp,  Philip  Coombs,  M.D.,  Boston,  1891. 
Laplace,    Ernest,   A.M.,   M.D.,  Philadelphia, 

1890,  1891. 
Lee,  John  G.,  M.D.,  Philadelphia,  1888. 
Leidy,  Joseph,  M.D.,  LL.D.,  Philadelphia,  1888, 

1889,  1890,  1891. 
Longstreth,  Morris,  M.D.,  Philadelphia,  1888, 

1889,  1890. 

Loomis,  Alfred  L.,  M.D.,   LL.D.,  New  York, 

1888,  1889. 
Lyman,  Henry  M.,  A.M.,  M.D.,  Chicago,  1888. 
McGuire,  Hunter,   M.D.,   LL.D.,   Richmond, 

1888. 
Manton,  Walter  P.,  M.D.,  F.R.M.S.,  Detroit, 

1888,  1889,  1S90,  1891. 

Martin,  H.  Newell,  M.D.,  M.A.,  Dr.  Sc,  F.R.S., 

Baltimore,  1888, 1889. 
Matas,   Rudolph,    M.D.,  New    Orleans,    1890, 

1891. 
Mears,  J.  Ewing,  M.D.,  Philadelphia,  1888, 1889, 

1890,  1891. 

Mills,  Charles  K.,  M.D.,  Philadelphia,  1888. 
Minot,   Chas.    Sedgwick,   M.D.,  Boston,  1888, 

1889,  1890,  1891. 

Montgomery,  E.  E.,  M.D.,  Philadelphia,  1891. 
Morton,  Thos.  G.,   M.D.,   Philadelphia,  1888, 

1889. 
Munde,  Paul  F.,  M.D.,  New  York,  1888,   1889, 

1890,  1891. 

Oliver,  Charles  A.,  A.M.,  M.D.,  Philadelphia, 

1889,  1890,  1891. 
Packard,  John  H.,  A.M.,  M.D.,  Philadelphia, 

1888,  1889,  1890,  1891. 

Parish,  Wm.  H.,  M.D.,  Philadelphia,  1888, 1889, 
1890. 

Parvin,  Theophilus,  M.D.,  LL.D.,  Philadel- 
phia, 1888,  1889. 

Pierce,  C.  N.,  D.D.S.,  Philadelphia,  1888. 

Pepper,  William,  M.D.,  LL.D.,  Philadelphia, 
1888. 

Rannev,  Ambrose  L.,  M.D.,  New  York,  1888, 

1889,  1890. 

Richardson,  W.  L.,  M.D.,Boston,  1888,  1889. 
Rockwell,  A.  D.,  A.M.,  M.D.,  New  York,  1891. 
Robe',  Geo.  H.,  M.D.,  Baltimore.  1888, 1889, 1890, 

1891. 
Sajous,  Chas.  E.,  M.D.,  Philadelphia.  1888, 1889, 

1890, 1891. 
Savre,  Lewis  A..  M.D.,  New  York.  1890,  1891. 
Seguin,  E.  C,  M.D.,    Providence,   1888,  1889, 

1890,  1891. 

Senn,  Nicholas,  M.D.,  Ph.D.,  Milwaukee,  1888, 

1889. 
Shakspeare,  E.  O.,  M.D.,  Philadelphia,  1888. 
Sliattuck,  F.  C,  M.D.,  Boston,  1890. 
Smith.  Allen  J.,  AjM.,  M.D.,  Philadelphia,  1890, 

1891. 
Smith,  J.  Lewis,  M.D.,  New  York,  1888,  1889, 

1890,  1891. 
Spitzka,  E.  C,  M.D.,  New  York,  1888. 
Starr,   Louis,   M.D.,   Philadelphia,  1888,  1889, 

1890,  1891. 
Stimson.  Lewis  A.,  M.D.,  New  York,  1888,  1889, 

1890,  1891. 
P;urgis.  F.  R.,  M.D.,  New  York,  1888. 
Suddutb,  F.  X.,  A.M..  M.D.,  F.R.M.S.,  Minne- 
apolis, 1888,  1889,  1890,  1891. 
Thomson,  William,  M.D.,  Philadelphia,  1888. 
Thomson,  Wm.  H.,  M.D..  New  York,  1888. 
Tiffanv,   L.  McLane,  A.M.,  M.D.,  Baltimore, 

1890.  1891. 
Turntmll.  Ohas,  S.,  M.D.,  Ph.D.,  Philadelphia, 

1888.  1889,  1890  1891. 
Tyson.  James,  M.D.,  Philadelphia,  1888,  1889, 

1890. 
Van  Harlingen,  Arthur,  M.D.,   Philadelphia, 

1888.  1889,  1890, 1891. 
Vander  Veer,  Albert,  M.D.,  Ph.D.;  Albanv, 

lxflO. 
Whittaker,  Jas.  T.,  M.D.,  Cincinnati,  1888, 1889, 

1890, 1891. 
Whittier,  E.  N.,  M.D.,  Boston,  1890,  1891. 
Wilson,  Jnmes  C,  A.M.,   M.D.,  Philadelphia, 

1888.  1889.  1890,  1891. 


Wirgman,  Chas.,  M.D.,  Philadelphia,  1888. 

Witherstine,  C.  Sumner,  M.S.,  M.D.,  Phila- 
delphia. 1888,  1889,  1890,  1891. 

White,  J.  William,  M.D.,  Philadelphia,  1889. 
1890,1891. 

Young,  Jas.  K.,  M.D.,  Philadelphia,  1891. 

JUNIOR   ASSOCIATE    EDITORS. 

Baldy,  J.  M.,  M.D.,  Philadelphia,  1890. 

Bliss.  Arthur  Ames,  A.  M.,  M.D.,  Philadelphia, 
1890,  1891. 

CattelJ,  H.  W.,  M.D.,  Philadelphia,  1890,  1891. 

Cerna,  David,  M.D.,  PhD.,  Philadelphia,  1891. 

Clark,  J.  Payson,  M.D.,  Boston,  1890.  1891. 

Crandall,  F.  M.,  M.D.,  New  York,  1891. 

Cohen,  Solomon  Solis,  A.M.,  M.D.,  Philadel- 
phia, 1890,  1891, 

Cryer,  H.  M.,  M.D.,  Philadelphia,  1889. 

Deale,  Henry  B.,  M.D..  Washington,  1891. 

Dolley,  C.  S.,  M.D.,  Philadelphia,  1889,  1890, 
1891. 

Dollinger.  Julius,  M.D.,  Philadelphia,  1889. 

Dorland,  W.  A.,  M.D.,  Philadelphia,  1891. 

Freeman,  Leonard,  M.D.,  Cincinnati,  1891. 

Goodell,  W.  Constantine,  M.D.,  Philadelphia, 

1888,  1889,  1890. 

Gould,  Geo.  M..M.D.,  Philadelphia,  1889,  1890. 

Greene,  E.  M..  M.D.,  Boston,  1891. 

Griffith,  J.  P.  Crozer,  M.D.,  Philadelphia,  1888. 

Hoag,  Junius,  M.D.,  Chicago,  1888. 

Howell,  W.  H.,  PhD.,  B.A.,  Baltimore,  1888, 

1889. 
Hunt,  William,  M.D.,  Philadelphia,  1888,  1889. 
Jackson,  Henry,  M.D.,  Boston,  1891. 
Kirk,  Edward  C.,  D.D.S..  Philadelphia,  1888. 
Lloyd,  James   Hendrie,  M.D.,  Philadelpha, 

1888 
McDonald,  Willis  G.,  M.D.,  Albanv,  1890. 
Penrose,  Chas.  B.,  M.D..  Philadelphia,  1890. 
Powell.  W.  M.,  M.D.,  Philadelphia,  1889,  1890, 

1891. 
Quimby,  Chas.  E.,  M.D.,  New  York,  1889. 
Sayre,  Reginald  H.,  M.D.,  New  York,  1890, 1891. 
Smith,    Allen  J.,  A.M.,  M.D.,    Philadelphia, 

1889,  1890. 

Viekery,  H.  F.,  M.D.,  Boston,  1891. 
Warfieid.  Ridgelv  B.,  M.D.,  Baltimore,  1891. 
Warner.  Frederick  M.,  M.D..  New  York.  1891. 
Weed.  Charles  L.,  A.M.,  M.D.,  Philadelphia, 

1888,1889. 
WTells.  Brooks  H.,  M.D.,  New  York,  1888,  1S89, 

1890, 1891. 
Wolff,  Lawrence,  M.D.,  Philadelphia,  1890. 
Wyman,  Walter,   A.M.,   M.D.,    Washington, 

1891. 

ASSISTANTS    TO    ASSOCIATE 
EDITORS. 

Baruch,  S.,  M.D.,  New  York.  1888. 
Beatty,  Franklin  T.,  M.D.,  Philadelphia,  1888. 
Brown,  Dillon,  M.D.,  New  York,  1888. 
Buechler,  A.  F.,  M.D.,  New  York,  1888. 
Burr,  Chas.  W.,  M.D.,  Philadelphia,  1891. 
Cohen,   Solomon    Solis,    M.D.,    Philadelphia, 

1889. 
Cooke,  B.  G.,  M.D.,  New  York,  1888. 
Coolidge,  Algernon,  Jr.,  M.D.,  Boston,  1890. 
Currier,  A.  F.,  M.D.,  New  York,  1888. 
Daniels.  F.  H.,  A.M.,  M.D.,  New  York,  188S. 
Deale,  Henry  B.,  M.D.,  Washington,  1890. 
Eshner,  A.  A.,  M.D.,  Philadelphia,  1891. 
Gould,  George  M.,  M.D.,  Philadelphia,  1888. 
Grand;n,  Egbert  H.,  M.D.,  New  York,  1S88, 

1889. 
Greene,  E.  M.,  M  D..  Boston,  1890. 
Guite'ras,  G.  M..  M.D..  Washington,  1890. 
Hance,  1.  H.,  A.M.,  M.D.,  New  York,  1891. 
Klingenschmidt,  C.  H.  A.,  M.D.,  Washington, 

1890. 
Martin,  Edward,  M.D.,  Philadelphia,  1891. 
McKee,  E.  S.,  M.D.,  Cincinnati,  1889,  1890, 1891. 
Myers,  F.  H.,  M.D..  New  York,  1888. 
Packard,  F.  A.,  M.D..  Philadelphia,  1S90. 
Pritchard.  W.  B„  M.D.,  New  York,  1891. 
Sangree,  E.  B..  A.M.,  M.D.,  Philadelphia,  1890. 
Sears,  G.  G.,  M.D..  Boston,  1890. 
Shulz,  R.  C,  M.D.,  New  York,  1891. 
Souwers,  Geo.  F.,  M.D.,  Philadelphia.  1888. 
Tavlor,  H.  L.,  M.D.,  Cincinnati,  1889,  1890. 
Va'nsant,  Eugene  L.,  M.D.,  Philadelphia,  1888. 


(28) 


Medical  Publication*  of  F.  A.  Davis,  Philadelphia. 


ASSISTANTS    TO    ASSOCIATE 
EDITORS-(continued). 

Vickery,  H.  F.,  M.D.,  Boston,  18!>0. 

Warner,  F.  M.,  M.D.,  New   York,  1888,  1889, 

Wells,  Brooks  H..M.D.,  New  York,  1888. 
Wendt,  E,  (J.,  M.D.,  New  York,  1888. 
Wilder,  VV.  H.,  M.D.,  Cincinnati,  1889. 
Wilson,  0.  Meigs,  M.D.,   Philadelphia,  1889. 
Wilson,  W.  U.,  M.D.,  Philadelphia,  1M01. 

CORRESPONDING    STAFF. 
EUROPE. 

Antal,  Dr.  Gesa  v.,  Puda-Pesth,  Hungary. 

Bagiusky,  Dr.  A.,  Berlin,  Germany. 

Baratoux,  Dr.  J.,  Paris,  Fiance. 

Barker,  Mr.  A.  10.  J.,  London,  England. 

Barnes,  Dr.  Fancourt,  London,  England. 

Bayer,  Dr.  Carl,  Prague,  Austria. 

Boucliut  Dr.  E.,  Paris,  France. 

Bourueville,  Dr.  A.,  Paris,  France. 

Bramwell,  Dr.  Byron,  Edinburgh,  Scotland. 

Carter,  Mr.  William,  Liverpool,  England. 

Caspari,  Dr.  G.  A.,  Moscow,  Russia. 

Chiralt  v  Selma,  Dr.  V.,  Seville,  Spain. 

Cordes,'Dr.  A.,  Geneva,  Switzerland. 

D'Estrees,  Dr.  Debout,  Contrexe'ville,  France. 

Diakonoff,  Dr.  P.  .1.,  Moscow,  Russia. 

Dobrashiau,  Dr.   G.  S.,  Constantinople,  Tur- 
key. 

Doleris,  Dr.  L,  Paris,  France. 

Doutrelcpont,  Prof.,  Bonn,  Germany. 

Doyon,  Dr.  H.,  Lyons,  France. 

Drzewiecki,  Dr.  Jos.,  Warsaw,  Poland. 

Dubois-Reymoncl,  Prof.,  Berlin,  Germany. 

Ducrey,  Dr.  A.,  Naples,  Italy. 

Dujardin-Beaumetz,  Dr.,  Paris,  France. 

Duke,  Dr.  Alexander,  Dublin,  Ireland. 

Eklund,  Dr.  F.,  Stockholm,  Sweden. 

P'okker,  Dr.  A.  P.,  Groningen,  Holland. 

Fort,  Dr.  J.  A.,  Paris,  France. 

Fournier,  Dr.  Henri,  Paris,  France. 

Franks,  Dr.  Kendal,  Dublin,  Ireland. 

Fremy.  Dr.  H.,  Nice,  France. 

Fry,  Dr.  George,  Dublin,  Ireland 

Go'lowina,  Dr.  A.,  Varna,  Bulgaria. 

Gouguenheim,  Dr.  A.,  Paris,  France. 

Haig,  Dr.  A.,  London,  England. 

Hamon,  Mr.  A.,  Paris,  France. 

Harlev,  Mr.  V.,  London,  England. 

Harley,  Mr.  H.  R.,  Nottingham,  England. 

Harley,  Prof.  Geo.,  London,  England. 

Harpe,  Dr.  de  la,  Lausanne,  Switzerland. 

Hartmann,  Prof.  Arthur,  Berlin,  Germany. 

Heitzmann,  Dr.  J.,  Vienna,  Austiia. 

Helferich,  Prof.,  Greifswald,  Germany. 

Hewetson,  Dr.  Bendelack,  Leeds,  England. 

Hoff,  Dr.  E.  M.,  Copenhagen,  Denmark. 

Humphreys,  Dr.  F.  Rowland,  London,   Eng- 
land. 

Illingworth,  Dr.  C.  K.,  Accrington,  England. 

Jones,  Dr.  D.  M.  de  Silva,  Lisbon,  Portugal. 

Knott,  Dr.  J.  F.,  Dublin,  Ireland. 

Krause,  Dr.  H.,  Berlin,  Germany. 

Landolt,  Dr.  E.,  Paris,  France. 

Levison,  Dr.  J.,  Copenliagen,  Denmark. 

Lutaud,  Dr.  A.,  Paris,  France. 

Mackay,  Dr.  W.  A.,  Huelva,  Spain. 

Mackowen,  Dr.  T.  C.,  Capri,  Italy. 

Manchc',  Dr.  L.,  Valetta,  Malta. 

Massei,  Prof.  F.,  Naples,  Italy. 

Mendez,  Prof.  R.,  Barcelona,  Spain. 

Meyer,  Dr.  E.,  Naples,  Italy. 

Meyer,  Prof.  W.,  Copenhagen.  Denmark. 

Monod,  Dr.  Charles,  Paris,  France. 

Montefusco,  Prof.  A.,  Naples,  Italy. 

More-Madden,  Prof.  Thomas,  Dublin,  Ireland. 

Morel,  Dr.  J.,  Ghent,  Belgium. 

Mygind,  Dr.  Holger,  Copenhagen,  Denmark. 

Mynlieff,  Dr.  A.,  Breukelen,  Holland. 

Napier,  Dr.  A.  D.  Leith.  London,  England. 

Nicolich,  Dr.,  Trieste,  Austria. 

Oberlander,  Dr.,  Dresden,  Germany. 

Obersteiner,  Prof.,  Vienna,  Austria. 

Pampoukis,  Dr.,  Athens,  Greece. 

Pansoni,  Dr.,  Naples,  Italy. 

Parker,  Mr.  Rushton,  Liverpool,  England. 

Pel,  Prof.  P.  K.,  Amsterdam,  Holland. 
Pippinskjold,  Dr.,  Helsingfors.  Finland. 
Puhdo,  Prof.  Angel,  Madrid,  Spain. 


Bona,  Dr.  S.,  Buda-Pesth,  Hungary. 

Kosenbuscb,  Dr.  L.,  Lvov.  (Jalieia. 

Rossbach,  Prof.  M.  F.,  Jena,  Germany. 

St.  Germain,  Dr.  de,  Paris,  France. 

Sanger,  Prof.  M.,  Leipzig,  Germany. 

Santa,  Dr.  P.  de  Pietra,  Paris,  France. 

Schiffers,  Prof.,  Liege,  Belgium. 

Solmiiegelow,    Prof.    E.,    Copenhagen,    Den- 
mark. 

Scott,  Dr.  G.  M.,  Moscow,  Russia. 

Simon,  Dr.  Jules,  Paris,  France. 

Sollier,  Dr.  P.,  Paris,  France. 

Solowieff,  Dr.  A.  N.,  Lipetz,  Russia. 

Sota,  Prof.  R.  de  la,  Seville,  Spain. 

Sprimont,  Dr.,  Moscow,  Russia. 

Stoekvis,  Prof.  B.  J.,  Amsterdam,  Holland. 

Szadek,  Dr.  Carl,  Kiew,  Russia. 

Tait,  Mr.  Lawson,  Birmingham,  England. 

Thiriar,  Dr..  Brussels,  Belgium. 

Trifiletti,  Dr.,  Naples,  Italy. 

Tuke,  Dr.  D.  Hack,  London,  England. 

Ulrik,  Dr.  Axel,  Copenhagen,  Denmark. 

Unverricht,  Prof.,  Jena,  Germany. 

Van  der  Mey,  Prof.  G.  H.,  Amsterdam,  Hol- 
land. 

Van  Leent,  Dr.  F.,  Amsterdam,  Holland. 
Van  Millingen,  Prof.  E.,  Constantinople,  Tur- 
key. 

Van  Rijnberk,  Dr.,  Amsterdam,  Holland. 

Wilson^  Dr.  George,  Leamington,  England. 

Wolfenden,  Dr.  Norris,  London,  England. 

Zweifel,  Prof.,  Leipzig,  Germany. 

AMERICA     AND     WEST     INDIES. 

Bittencourt,  Dr.  J.  C,  Rio  Janeiro,  Brazil. 
Cooper,  Dr.  Austin  N.,  Buenos  Ayres,  Argen- 
tine Republic. 
Dagnino,  Prof.  Manuel,  Caracas,  Venezuela. 
Desvernine,  Dr.  C.  M.,  Havana,  Cuba. 
Fernandez,  Dr.  J.  L.,  Havana,  Cuba. 
Finlay,  Dr.  Charles,  Havana,  Cuba. 
Fontecha,  Prof.  R.,  Tegucigalpa,  Honduras. 
Harvey,  Dr.  Eldon,  Hamilton,  Bermuda. 
Herdocia,  Dr.  E.  Leon,  Nicaragua. 
Levi,  Dr.  Joseph,  Colon,  U.  S.  Columbia. 
Mello.  Dr.  Vierra  de,  Rio  Janeiro,  Brazil. 
M©ir,  Dr.  J.  W.,  Belize,  British  Honduras. 
Moncorvo,  Prof.,  Rio  Janeiro,  Brazil. 
Pla,  Dr.  E.  F..  Havana,  Cuba. 
Rake,  Dr.  Beaven,  Trinidad. 
Rincon,  Dr.  F.,  Maraeaibo,  Venezuela. 
Semeleder,  Dr.  F.,  Mexico,  Mexico. 
Soriano,  Dr.  M.  S.,  Mexico,  Mexico. 
Strachan,  Dr.  Henry,  Kingston,  Jamaica. 

OCEANICA,     AFRICA,     AND     ASIA. 

Baelz,  Prof.  R.,  Tokyo,  Japan. 
Barrett,  Dr.  Jas.  W.,  Melbourne,  Australia. 
Branfoot,  Dr.  A.  M.,  Madras,  India. 
Carageorgiades,  Dr.  J.  G.,  Liinassol,  Cyprus. 
Cochran,  Dr.  Joseph  P.,  Oroomiah,  Persia. 
Coltman,  Dr.  Robert,  Jr.,  Che-foo,  China. 
Condict,  Dr.  Alice  W.,  Bombay,  India. 
Creece,  Dr.  John  M.,  Sydney,  Australia. 
Dalzell,  Dr.  J.,  Umsiga,  Natal. 
Diamantopulos,  Dr.  Geo.,  Smyrna,  Turkey. 
Drake-Brockman,  Dr.,  Madras,  India. 
Fitzgerald.Mr.  T.  N.,  Melbourne,  Australia. 
Foreman,  Dr.  L.,  Sydney,  Australia. 
Gaidzagian,  Dr.  Ohan,  Adana,  Asia  Minor. 
Grant,  Dr.  David,  Melbourne,  Australia. 
Johnson,  Dr.  R.,  Dera  Ishmail  Khan,  Beloo- 

chistan. 
Kimura,  Prof.  J.  K.,  Tokyo,  Japan. 
Knaggs,  Dr.  S.,  Sydney,  Australia. 
Manasseh,  Dr.  Beshara  I.,  Brummana,  Turkey 

in  Asia. 
McCandless,  Dr.  H.  H.  Hainan,  China. 
Moloney,  Dr.  J.,  Melbourne,  Australia. 
Neve,  Dr.  Arthur,  Bombay,  India. 
Perez,  Dr.  George  V.,  Puerto  Orotava,  Tene- 

riffe. 
Reid,  Dr.  John,  Melbourne,  Australia. 
Robertson,  Dr.  W.  S.,  Port  Said,  Egypt. 
Rouvier,  Prof.  Jules,  Beyrouth,  Syria. 
Scranton,  Dr.  William  B.,  Seoul,  Corea. 
Sinclair,  Dr.  H.,  Sydney,  Australia. 
Thompson,  Dr.  Jaines  B  ,  Petchaburee,  Si  am. 
Wheeler,  Dr.  P.  d'E.,  Jerusalem,  Palestine. 
Whitney,  Dr.  H.  T.,  Foochow,  China. 
Whitney,  Dr.  W.  Norton,  Tokyo,  Japan. 


(29) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


Lectures  on  Nervous  Diseases. 

From  the  Stand-Potnt  of  Cerebral  and   Spinal  Localization,  and 

the  Later  Methods  Employed  in  the  Diagnosis  and 

Treatment  of  these  Affections. 

By  Ambrose  L.  Ranney,  A.M.,  M.D.,  Professor  of  the  Anatomy  Mid 
Physiology  of  the  Nervous  System  in  the  New  York  Post-Graduate 
Medical  School  and  Hospital ;  Professor  of  Nervous  and  Mental  Diseases 
in  the  Medical  Department  of  the  University  of  Vermont,  etc. ;  Author 
of"  The  Applied  Anatomy  of  the  Nervous  System,"  "  Practical  Medical 
Anatomy,"  etc.,  etc. 

It  is  now  generally  conceded  that  the  nervous  system  controls  all 
of  the  physical  functions  to  a  greater  or  less  extent,  and  also  that  most 
of  the  symptoms  encountered  at  the  bedside  can  be  explained  and 
interpreted  from  the  stand-point  of  nervous  physiology. 

Profusely  illustrated  with  original  diagrams  and  sketches  in  color 
by  the  author,  carefully  selected  wood-engravings,  and  reproduced  photo- 
graphs of  typical  cases.    One  handsome  royal  octavo  volume  of  180  pages. 

SOLD  ONLY  BY  SUBSCRIPTION,  OK  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Cloth,  $5  50;  Sheep,  $6.50;  Half-Russia,  $7.00. 
Canada  (duty  paid),  Cloth,  $6.05;  Sheep,  $7.15 ;  Half-Russia,  $7.70. 
Great  Britain,  Cloth,  32s. ;  Sheep,  37s.  6d. ;  Half-Russia,  40s.  Prance, 
Cloth,  31  fr.  70;  Sheep,  40  fr.  45;  Half-Russia,  43  fr.  30. 


We  are  giad  to  note  that  Dr.  Ranney  has 
published  in  book  form  his  admirable  lectures 
on  nervous  diseases.  His  book  contains  over 
seven  hundred  large  pages,  and  is  profusely 
illustrated  with  original  diagrams  and  sketches 
in  colors,  and  with  many  carefully  selected 
wood-cuts  and  reproduced  photographs  of 
typical  cases.  A  large  amount  of  valuable 
information,  not  a  little  of  which  has  but 
recently  appeared  in  medical  literature,  is  pre- 


sented in  compact  form,  and  thus  made  easily 
accessible.  In  our  opinion,  Dr.  Ranney's  book 
ought  to  meet  with  a  cordial  reception  at  the 
hands  of  the  medical  profession,  for,  even 
though  the  author's  views  may  be  sometimes 
open  to  question,  it  cannot  be  disputed  that 
his  work  bears  evidence  of  scientific  method 
and  honest  opinion. — American  Journal  of 
Insanity. 


STA^rroisr'S 


Practical  and  Scientific  Physiognomy; 

OR 

9 

I*ECo\s7-    to    IFS-^a-d    Faces. 

By  Mary  Olmsted  Stanton.  Copiously  illustrated.  Two  large 
Octavo  volumes. 

The  author,  Mrs.  Mary  O.  Stanton,  has  given  over  twenty  years  to 
the  preparation  of  this  work.  Her  style  is  easy,  and,  by  her  happy 
method  of  illustration  of  every  point,  the  hook  reads  like  a  novel  and 
memorizes  itself.  To  physicians  the  diagnostic  information  conveyed  is 
invaluable.  To  the  general  reader  each  page  opens  a  new  train  of  ideas. 
(This  book  has  no  reference  whatever  to  phrenoIogjO 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Cloth,  $9.00;  Sheep,  $11.00 ;  Half-Russia,  $13.00. 
Canada  (duty  paid),  Cloth,  $10.00;  Sheep,  $12.10;  Half-Russia, 
$14.30.  Great  Britain,  Cloth,  56s. ;  Sheep,  68s. ;  Half-Russia,  80s. 
France,  Cloth,  30  fr.  30 ;  Sheep,  36  fr.  40 ;  Half-Russia,  43  fr,  30. 

(30) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
SAJO  US 

Lectures  on  the  Diseases  of  the  Nose 
and  Throat. 

Delivered  at  the  Jefferson  Medical  College,  Philadelphia. 

By  Charles  E.  Sajous,  M.D.  Formerly  Lecturer  on  Rhinology  and 
Laryngology  in  Jefferson  Medical  College;  Vice-President  of  the 
American  Larvngological  Association;  Officer  of  the  Academy  of 
France  and  of  Public  Instruction  of  Venezuela;  Corresponding  Member 
of  the  Royal  Society  of  Belgium,  of  the  Medical  Society  of  Warsaw 
(Poland),  and  of  the  Society  of  Hygiene  of  France  ;  Member  of  the 
American  Philosophical  Society,  etc.,  etc. 

l^glT" Since  the  publisher  brought  this  valuable  work  before  the  pro- 
fession, it  has  become:  1st,  the  text-book  of  a  large  number  of  colleges; 
2d,  the  reference-book  of  the  U.  S.  Army,  Navy,  and  the  Marine  Service; 
and.  3d,  an  important  and  valued  addition  to  the  libraries  of  over  10,000 
physicians. 

This  book  has  not  only  the  inherent  merit  of  presenting  a  clear 
expose. of  the  subject,  but  it  is  written  with  a  view  to  enable  the  general 
practitioner  to  treiit  his  cases  himself.  To  facilitate  diagnosis,  colored 
plates  are  introduced,  showing  the  appearance  of  the  different  parts  in 
the  diseased  state  as  they  appear  in  nature  by  artificial  light.  No  error 
can  thus  be  made,  as  each  affection  of  the  nose  and  throat  has  its  repre- 
sentative in  the  100  chromo-lithographs  presented.  In  the  matter  of 
treatment,  the  indications  are  so  complete  that  even  the  slightest  pro- 
cedures, folding  of  cotton  for  the  forceps,  the  use  of  the  probe,  etc.,  are 
ciearly  explained. 

Illustrated  with  100  chromo-lithographs,  from  oil  paintings  by  the 
author,  and  93  engravings  on  wood.    One  handsome  royal  octavo  volume. 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Cloth,  Royal  Octavo,  $4.00;  Half-Russia,  Royal 
Octavo,  $5.00.  Canada  (duty  paid),  Cloth,  $4.40 ;  Half-Russia,  $5.50. 
Great  Britain,  Cloth,  22s.  Sd. ;  Sheep  or  Half-Russia,  28s.  Prance, 
Cloth,  24  ft.  60 ;  Half- Russia,  30  fr.  3a 


It  is  intended  to  furnish  the  general  practi- 
tioner not  only  with  a  guide  for  the  treatment 
of  diseases  of  the  nose  and  throat,  hut  also  to 
place  before  him  a  representatien  of  the  nor- 
mal and  diseased  parts  as  they  would  appear 


to  him  were  they  seen  in  the  firing  subject. 
As  a  guide  to  the  treatment  of  the  nose  and 
throat,  we  can  cordially  recommend  this  work. 
— Boston  Medical  and  Surgical  Journal. 


XHT    FBESS. 

THE  CHINESE:  Their  Present  and  Future ;  Medical,  Political,  and  Social. 

By  ROBERT  COLTMAN,  Jr.,  M.D  ,  Surgeon  in  Charge  of  the  Presbyterian 
Hospital  and  Dispensary  at  Teng  Chow  Fn;  Consulting  Physician  of  the  American 
Southern  Baptist  Mission  Society;  Examiner  in  Surgery  and  Diseases  of  the  Eye 
for  the  Shantung  Medical  Class;  Consulting  Physician  to  the  English  Baptist 
Missions,  etc.  Illustrated  with  about  Sixteen  Fine  Engravings  from  photographs 
of  persons,  places,  and  objects  characteristic  of  China.  In  one  Octavo  volume  of 
about  250  pages.     Ready  About  December  1,  1891. 

The  author  has  spent  many  years  among  the  Chinese;  lived  with  them 
in  their  dwellings;  thoroughly  learned  the  language;  lias  become  conversant 
with  all  their  strange  and  odd  characteristics  to  a  greater  extent  than  almost  any 
other  American.  He  has  been  a  physician  to  all  classes  of  this  wonderful  people, 
and  the  opportunities  thus  afforded  for  a  clear  insight  into  the  inner  life  of  the 
Chinese,  their  virtues  and  vices,  political,  social,  and  sanitary  condition,  probale 
destiny,  and  their  present  important  position  in  the  world  to-day,  have  been,  ably 
and  wisely  used  by  Dr.  Coltman. 

t31> 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
Nearly  Ready.     Will  be  Issued  about  October  1,  1891. 


e  of  the  Domestic  Animals. 

Being  a   Complete   Treatise  on   the   Dentition   of  the   Horse,  Ox, 

Sheep,  Hog,  and  Dog,  and  on  the  Various  Other  Means 

ob  Telling  the  Age  of  these  Animals. 

By  Rush  Shippen  Huidekoper,  M.D.,  Veterinarian,  Alfort,  France. 
Professor  of  Sanitary  Medicine  and  Veterinary  Jurisprudence  in  the 
American  Veterinary  College,  New  York ;  Lieutenant-Colonel  and  Sur- 
geon-in-Chief  National  Guard  of  Pennsylvania;  Fellow  of  the  College 
of  Physicians,  Philadelphia;  Honorary  Fellow  of  the  Royal  College 
Veterinaiy  Surgeons,  London  ;  Late  Dean  of  the  Veterinary  Department 
University  of  Pennsjdvania,  etc.,  etc. 

Complete  in  one  handsome  Royal  Octavo  volume,  with  about  160 
Illustrations.  This  is  one  of  the  most  important  works  on  the  domestic 
animals  published  in  recent  years. 


Heady  Very  Shortly. 


A,  8,  C  of  the  Swedish  System  of 

Educational  Gymnastics. 

A  Practical  Hand-Book  for  School-Teachers  and  the  Home. 

By  Hartvig  Nissen,  Instructor  of  Physical  Training  in  the  Public 
Schools  of  Boston,  Mass.;  Instructor  of  Swedish  and  German  Gymnas- 
tics at  Harvard  University's  Summer  School,  1891 ;  Author  of  "  A 
Manual  on  Swedish  Movement  and  Massage  Treatment,"  etc.,  etc. 

Complete  in  one  neat  12mo  volume,  bound  in  extra  flexible  cloth 
and  appropriately  illustrated  with  T7  excellent  engravings  aptly  eluci- 
dating the  text. 


Lectures  on  Auto-Intoxication. 

By  Prof.  Bouchard,  Paris.  Translated  from  the  French,  with  an 
Original  Appendix  b.y  the  author.  By  Thomas  Oliver,  M.D.,  Professor 
of  Physiology  in  University  of  Durham,  England.     In  Press. 


(88) 


